1952679011 NPI number — MR. TERRY LAMONT SPELLER SR. LCAS-A

Table of content: MR. TERRY LAMONT SPELLER SR. LCAS-A (NPI 1952679011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952679011 NPI number — MR. TERRY LAMONT SPELLER SR. LCAS-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPELLER
Provider First Name:
TERRY
Provider Middle Name:
LAMONT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
LCAS-A
Provider Gender Code:
M

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:
1952679011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
482 WILLIAMSTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTERVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28590-9415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-347-3950
Provider Business Mailing Address Fax Number:
252-364-2631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
482 WILLIAMSTON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTERVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28590-9514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-347-3950
Provider Business Practice Location Address Fax Number:
252-364-2631
Provider Enumeration Date:
12/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LCAS . This is a "2619-A" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com