1861712234 NPI number — TATE CLINIC, PA

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 1861712234 NPI number — TATE CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TATE CLINIC, PA
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:
1861712234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 843
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28646-0843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-737-7917
Provider Business Mailing Address Fax Number:
828-737-6869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRUCE PINE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-765-4201
Provider Business Practice Location Address Fax Number:
828-737-6869
Provider Enumeration Date:
06/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TATE, II
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
828-737-7917

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GROUP#02822 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: GROUP#8902822 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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