1760468110 NPI number — WILLIAM PAUL BANISH MD

Table of content: WILLIAM PAUL BANISH MD (NPI 1760468110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760468110 NPI number — WILLIAM PAUL BANISH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANISH
Provider First Name:
WILLIAM
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1760468110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 604350
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:
28260-4350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-364-8100
Provider Business Mailing Address Fax Number:
704-365-2073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 MATTHEWS TOWNSHIP PKWY STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28105-5331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-841-1444
Provider Business Practice Location Address Fax Number:
704-849-2520
Provider Enumeration Date:
12/19/2005

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: 208600000X , with the licence number:  19490 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 2015-00687 , 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: 770001362 . This is a "BANKERS LIFE AND CASUALTY" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 9645030 . This is a "GHI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 620108 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 76051 . This is a "MEDCOST" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 9377345 . This is a "CIGNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: T37948 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760468110 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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