1881643419 NPI number — WILLIAM J ONEILL

Table of content: (NPI 1881643419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881643419 NPI number — WILLIAM J ONEILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM J ONEILL
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:
6
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:
1881643419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 268
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEMMONS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27012-0268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-766-8400
Provider Business Mailing Address Fax Number:
336-766-8486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6341 COOK AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CLEMMONS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27012-9379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-766-8400
Provider Business Practice Location Address Fax Number:
336-766-8486
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REAVIS
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
BUSINESS MGR
Authorized Official Telephone Number:
336-766-8400

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8908042 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08042 . This is a "BLUE CROSS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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