Basic Information
| Provider Information | |||||||||
| NPI: | 1134114127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEWICK | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | WINSTON | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 W H SMITH BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278343763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527572663 | ||||||||
| FaxNumber: | 2523170829 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 W H SMITH BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278343763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527572663 | ||||||||
| FaxNumber: | 2523170829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 102827 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 970011661 | 01 | RAILROAD MEDICARE | OTHER | 1274070001 | 01 | DME MAC JURISDICTION C | OTHER |