1841729001 NPI number — RELIANCE MEDICAL MANAGEMENT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841729001 NPI number — RELIANCE MEDICAL MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIANCE MEDICAL MANAGEMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841729001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4242 SIX FORKS RD STE 1550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-6084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
984-220-8380
Provider Business Mailing Address Fax Number:
919-889-8321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4242 SIX FORKS RD STE 1550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-6084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-220-8380
Provider Business Practice Location Address Fax Number:
919-889-8321
Provider Enumeration Date:
06/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HAMPTON
Authorized Official First Name:
DEIDRE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
984-220-8380

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: .......... . This is a "MEDICAL BILLING SERVICES" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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