1922160670 NPI number — EZCARE PROVIDERS INC

Table of content: ANDREW THOMAS PALMER PT, DPT (NPI 1225625171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922160670 NPI number — EZCARE PROVIDERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EZCARE PROVIDERS INC
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:
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:
1922160670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21743
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27420-1743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-638-6634
Provider Business Mailing Address Fax Number:
336-274-1078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4202 SCOTNEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27407-7558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-638-6634
Provider Business Practice Location Address Fax Number:
336-274-1078
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OKORO
Authorized Official First Name:
RICHMOND
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
336-638-6634

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL-041-762 , 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: 3418227 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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