Healthcare Provider Details

I. General information

NPI: 1528314754
Provider Name (Legal Business Name): CHAMPION HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 NEW BERN AVE STE. 108
RALEIGH NC
27610-1248
US

IV. Provider business mailing address

2949 NEW BERN AVE STE. 108
RALEIGH NC
27610-1248
US

V. Phone/Fax

Practice location:
  • Phone: 919-500-3464
  • Fax: 919-800-3413
Mailing address:
  • Phone: 919-500-3464
  • Fax: 919-800-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BYRON KEITH WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 919-434-5100