1972554186 NPI number — DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972554186 NPI number — DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO
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:
6
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:
1972554186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5550 77 CENTER DR STE 320
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:
28217-0739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-295-4653
Provider Business Mailing Address Fax Number:
704-295-4288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 BILLINGSLEY RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-347-3900
Provider Business Practice Location Address Fax Number:
704-347-0133
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOCK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
RAYLE
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
704-295-4653

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890328M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZAN993 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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