1962637801 NPI number — TSH-PDN SERVICES

Table of content: (NPI 1962637801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962637801 NPI number — TSH-PDN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TSH-PDN SERVICES
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:
1962637801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 242036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28224-2036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-493-3422
Provider Business Mailing Address Fax Number:
704-525-2506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
756 TYVOLA RD
Provider Second Line Business Practice Location Address:
SUITE 143
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28217-3588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-493-3422
Provider Business Practice Location Address Fax Number:
704-525-2506
Provider Enumeration Date:
05/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SOUTHERLAND
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
704-493-3422

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com