Basic Information
| Provider Information | |||||||||
| NPI: | 1134575913 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNC SCHOOL OF MEDICINE AND HEALTH CARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 DENTAL CIR | ||||||||
| Address2: | ROOM 4032 BURNETT-WOMACK BLDG., CB#7050 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275995021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199664653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 160 DENTAL CIR | ||||||||
| Address2: | ROOM 4032 BURNETT-WOMACK BLDG., CB#7050 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275995021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199664653 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2016 | ||||||||
| LastUpdateDate: | 05/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | BUNDRANT | ||||||||
| AuthorizedOfficialFirstName: | NIKKIDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL SURGERY RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5408403769 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 218624 | NC | Y | Hospitals | General Acute Care Hospital |
No ID Information.