Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 291U00000X | Clinical Medical Laboratory | | 34D0865177 | NORTH CAROLINA | No |
| 2 | 3336C0002X | Pharmacy | Clinic Pharmacy | 04803 | NORTH CAROLINA | No |
| 3 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 4 | 251B00000X | Case Management | | | | No |
| 5 | 261QM2500X | Clinic/Center | Medical Specialty | | | No |
| 6 | 261QC1500X | Clinic/Center | Community Health | | | No |
| 7 | 261QD0000X | Clinic/Center | Dental | | | No |
| 8 | 261QF0050X | Clinic/Center | Family Planning, Non-Surgical | | | No |
| 9 | 291U00000X | Clinical Medical Laboratory | | 34D0692393 | NORTH CAROLINA | No |
| 10 | 261QP0905X | Clinic/Center | Public Health, State or Local | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 04803 | OTHER | NORTH CAROLINA | PHARMACY PERMIT NUMBER |
| 2 | 0721J | OTHER | NORTH CAROLINA | BCBS OF NC HEALTH INS |
| 3 | ========= | OTHER | NORTH CAROLINA | OTHER INSURANCE |
| 4 | 3404364 | MEDICAID | NORTH CAROLINA | |
| 5 | 34D0692393 | OTHER | NORTH CAROLINA | CLIA LAB NUMBER |
| 6 | 34D0865177 | OTHER | NORTH CAROLINA | CLIA LAB NUMBER |
