1912977802 NPI number — MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA

Table of content: (NPI 1912977802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912977802 NPI number — MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG 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:
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:
1912977802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 PENNY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOREHEAD CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-247-2258
Provider Business Mailing Address Fax Number:
252-247-7783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 PENNY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-247-2258
Provider Business Practice Location Address Fax Number:
252-247-7783
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VINTON
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
RALPH
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
252-247-2258

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  4872 , 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: 1749169 . This is a "UNITED CONCORDIA, DR. LON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 899000L , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8997871 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9018P . This is a "BCBSNC, LONG" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 97871 . This is a "BCBSNC, SMITH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 822407 . This is a "UNITED CONCORDIA, SMITH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 899018P , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 79096 . This is a "UNITED CONCORDIA, VINTON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9000L . This is a "BCBSNC, VINTON" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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