1801162417 NPI number — TIMOTHY JAMES CARPENTER II CRNA

Table of content: TIMOTHY JAMES CARPENTER II CRNA (NPI 1801162417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801162417 NPI number — TIMOTHY JAMES CARPENTER II CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
TIMOTHY
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
CRNA
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:
1801162417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2485 HEMBY LN
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27834-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-752-2140
Provider Business Mailing Address Fax Number:
888-787-2249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2485 HEMBY LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-752-2140
Provider Business Practice Location Address Fax Number:
888-787-2249
Provider Enumeration Date:
03/28/2012

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: 163W00000X , with the licence number:  163278 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 89986 , 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: 1801162417 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8054193 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P1111572 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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