Basic Information
Provider Information | |||||||||
NPI: | 1659378891 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BINDEWALD | ||||||||
FirstName: | ERIC | ||||||||
MiddleName: | STEWART | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 INDEPENDENCE PT | ||||||||
Address2: | STE. 212 | ||||||||
City: | GREENVILLE | ||||||||
State: | SC | ||||||||
PostalCode: | 296154545 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8647976306 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 800 N JUSTICE ST | ||||||||
Address2: |   | ||||||||
City: | HENDERSONVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 287913410 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286961000 | ||||||||
FaxNumber: | 8286961314 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/01/2005 | ||||||||
LastUpdateDate: | 08/27/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9830 | SC | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 9801172 | NC | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 9830 | SC | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | P00203237 | 01 |   | RAILROAD MEDICARE | OTHER | PENDING | 05 | SC |   | MEDICAID | 891196Q | 05 | NC |   | MEDICAID | 1196Q | 01 | NC | BCBS | OTHER |