1962580985 NPI number — MRS. AMY M. YORK PA

Table of content: MRS. AMY M. YORK PA (NPI 1962580985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962580985 NPI number — MRS. AMY M. YORK PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YORK
Provider First Name:
AMY
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCMINN
Provider Other First Name:
AMY
Provider Other Middle Name:
LAUREN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962580985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 INNOVATION DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29607-5261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-235-7665
Provider Business Mailing Address Fax Number:
864-233-5971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 INNOVATION DR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29607-5261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-235-7665
Provider Business Practice Location Address Fax Number:
864-233-5971
Provider Enumeration Date:
11/01/2006

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: 363A00000X , with the licence number:  1152 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP0975 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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