1952739088 NPI number — LIASION

Table of content: (NPI 1952739088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952739088 NPI number — LIASION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIASION
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:
1952739088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 E ASH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27530-3855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-734-0142
Provider Business Mailing Address Fax Number:
919-734-0143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405A S POINTE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTERVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28590-9891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-738-1837
Provider Business Practice Location Address Fax Number:
919-738-1837
Provider Enumeration Date:
10/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BATTLE
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
MARGARET
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
919-734-0142

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  096-252 , 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: 096-252 . This is a "STATE OF NORTH CAROLINA DEPARTMENT OF THE SEC. OF STATE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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