1922083898 NPI number — JOHN CHARLES GERANCHER III MD

Table of content: JOHN CHARLES GERANCHER III MD (NPI 1922083898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922083898 NPI number — JOHN CHARLES GERANCHER III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERANCHER
Provider First Name:
JOHN
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
Provider Name Suffix Text:
III
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:
1922083898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26851
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27114-6851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3331 HEALY DR
Provider Second Line Business Practice Location Address:
#26851
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-408-1036
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2005

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: 207LP2900X , with the licence number:  9500077 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 9500077 , 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: 12707 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5152060 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 893510H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1802064000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3510H . This is a "BCBS OF NC" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q0007B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5708150 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89600 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com