1922165018 NPI number — CARY GASTROENTEROLOGY ASSOCIATES PA

Table of content: (NPI 1922165018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922165018 NPI number — CARY GASTROENTEROLOGY ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARY GASTROENTEROLOGY ASSOCIATES 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:
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:
1922165018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 KILDAIRE PARK DR STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27518-8144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-816-4948
Provider Business Mailing Address Fax Number:
919-233-7685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 KILDAIRE PARK DR STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27518-8144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-816-4948
Provider Business Practice Location Address Fax Number:
919-233-7685
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALLAN
Authorized Official First Name:
NOLA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
919-816-4948

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0115H . This is a "BCBS GRP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8934199 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34199 . This is a "STEPHEN FURS NCBCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8911680 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7928291 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890115H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8967772 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com