1952443988 NPI number — UNIVERSAL MHDDSAS

Table of content: DR. CHRISTOPHER BROCK WOODIS PHARM.D., CPP (NPI 1417253923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952443988 NPI number — UNIVERSAL MHDDSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL MHDDSAS
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:
1952443988
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:
839 WILKESBORO BLVD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENOIR
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28645-4612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-759-2228
Provider Business Mailing Address Fax Number:
828-759-0159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
397 3RD AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28681-4180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-632-7005
Provider Business Practice Location Address Fax Number:
828-632-0435
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
BROOK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
828-759-4064

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6005060 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5900301 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300457B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300457G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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