1548539646 NPI number — FIRSTHEALTH OF THE CAROLINAS INC

Table of content: (NPI 1548539646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548539646 NPI number — FIRSTHEALTH OF THE CAROLINAS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRSTHEALTH OF THE CAROLINAS INC
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:
FIRSTHEALTH OUTPATIENT PHARMACY
Provider Other Organization Name Type Code:
3
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:
1548539646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEHURST
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28374-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-715-4250
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEHURST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28374-8710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-715-4250
Provider Business Practice Location Address Fax Number:
910-715-4255
Provider Enumeration Date:
12/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MARQUIS-HENKE
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
AMBULATORY PHARMACY MANAGER
Authorized Official Telephone Number:
910-715-6248

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  11169 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2133054 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0635783 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com