1922256254 NPI number — NC MEDTECH PLLC

Table of content: (NPI 1922256254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922256254 NPI number — NC MEDTECH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NC MEDTECH PLLC
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:
1922256254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10620 PARK RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28210-8472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-541-7654
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10620 PARK RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28210-8472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-866-9951
Provider Business Practice Location Address Fax Number:
877-284-8933
Provider Enumeration Date:
08/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PRATT
Authorized Official First Name:
BROC
Authorized Official Middle Name:
LANE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-541-7654

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  77796 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X , with the licence number: 77796 , 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)





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