1942371919 NPI number — EBERHARDT FOOT & ANKLE CLINIC

Table of content: (NPI 1942371919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942371919 NPI number — EBERHARDT FOOT & ANKLE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EBERHARDT FOOT & ANKLE CLINIC
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:
1942371919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 DENNIS DR STE 123
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27330-6461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-776-0300
Provider Business Mailing Address Fax Number:
919-776-0511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 DENNIS DR STE 123
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27330-6461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-776-0300
Provider Business Practice Location Address Fax Number:
919-776-0511
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EBERHARDT
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
NEAL
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
919-776-0300

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  332 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0297L . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890806K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2336170 . This is a "MEDICARE LEGACY NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 890297L , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0297L . This is a "BC/BS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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