Basic Information
| Provider Information | |||||||||
| NPI: | 1770560591 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BESTPRACTICES OF NORTH CAROLINA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 759108 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212759108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888983291 | ||||||||
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| Practice Location | |||||||||
| Address1: | 509 N BRIGHTLEAF BLVD | ||||||||
| Address2: | |||||||||
| City: | SMITHFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275774407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199348171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | MAYER | ||||||||
| AuthorizedOfficialFirstName: | THOM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8888983291 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89016EW | 05 | NC | MEDICAID | DC6910 | 01 | NC | RAILROAD MEDICARE | OTHER |