Basic Information
| Provider Information | |||||||||
| NPI: | 1902800949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1125 CARTHAGE ST | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273304162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197746023 | ||||||||
| FaxNumber: | 9197766359 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CHURCH STREET | ||||||||
| Address2: | |||||||||
| City: | BROADWAY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192586521 | ||||||||
| FaxNumber: | 9192586693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 06/15/2010 | ||||||||
| 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 | 207Q00000X | 28163 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 24916 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 8924965 | 05 | NC | MEDICAID | 22494 | 01 | NC | MEDCOST | OTHER | 270329 | 01 | NC | MAMSI | OTHER | 0138852 | 01 | NC | UNITED HEALTHCARE | OTHER | 080104308 | 01 | NC | RR MEDICARE | OTHER | 3915 | 01 | NC | PARTNERS | OTHER |