1902833171 NPI number — WILLIAM C LELIEVER MD

Table of content: WILLIAM C LELIEVER MD (NPI 1902833171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902833171 NPI number — WILLIAM C LELIEVER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LELIEVER
Provider First Name:
WILLIAM
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1902833171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1915 K M WICKER MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27330-5070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-774-6829
Provider Business Mailing Address Fax Number:
919-775-2327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1915 KM WICKER MEMORIAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-774-6829
Provider Business Practice Location Address Fax Number:
919-775-2327
Provider Enumeration Date:
06/26/2006

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: 207Y00000X , with the licence number:  30932 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237700000X , with the licence number: 30932 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8951664 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040001933 . This is a "PALMETTO GBA-RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3404108 . This is a "MEDICAID - HEARING AID CLAIMS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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