1871732016 NPI number — MR. SHANNON SCOTT AIKEN CPO

Table of content: MR. SHANNON SCOTT AIKEN CPO (NPI 1871732016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871732016 NPI number — MR. SHANNON SCOTT AIKEN CPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AIKEN
Provider First Name:
SHANNON
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CPO
Provider Gender Code:
M

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:
1871732016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3885
Provider Second Line Business Mailing Address:
DUMC
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27710-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-684-2474
Provider Business Mailing Address Fax Number:
919-681-8496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DUMC M04 DAVISON BUILDING
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27710-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-684-2474
Provider Business Practice Location Address Fax Number:
919-681-8496
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X , with the licence number:  CPO03081 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X , with the licence number: CPO03081 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7795429 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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