1982701215 NPI number — WEST COLUMBUS FAMILY PRACTICE, P.A.

Table of content: SHELLEY RUTH SALPETER MD (NPI 1770688848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982701215 NPI number — WEST COLUMBUS FAMILY PRACTICE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COLUMBUS FAMILY PRACTICE, P.A.
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:
1982701215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 N BROWN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHADBOURN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28431-1716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-654-1701
Provider Business Mailing Address Fax Number:
910-654-5701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHADBOURN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28431-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-654-1701
Provider Business Practice Location Address Fax Number:
910-654-5701
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAVER
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO OWNER
Authorized Official Telephone Number:
910-654-1701

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 344634A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 344634C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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