1144275165 NPI number — MS. TIFFANY HORTON PA-C

Table of content: MS. TIFFANY HORTON PA-C (NPI 1144275165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144275165 NPI number — MS. TIFFANY HORTON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORTON
Provider First Name:
TIFFANY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1144275165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-3634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-641-8600
Provider Business Mailing Address Fax Number:
910-641-8605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-641-8600
Provider Business Practice Location Address Fax Number:
910-641-8605
Provider Enumeration Date:
05/24/2006

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: 207Q00000X , with the licence number:  103683 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 103683 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103683 . This is a "STATE LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1144275165 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2640PA , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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