Healthcare Provider Details

I. General information

NPI: 1255659512
Provider Name (Legal Business Name): CAH ACQUISITION COMPANY 10 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W MAIN ST
YADKINVILLE NC
27055-7804
US

IV. Provider business mailing address

1100 MAIN ST STE 2350
KANSAS CITY MO
64105-5186
US

V. Phone/Fax

Practice location:
  • Phone: 336-679-2041
  • Fax: 336-679-6717
Mailing address:
  • Phone: 336-679-2041
  • Fax: 336-679-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0155
License Number StateNC

VIII. Authorized Official

Name: MRS. JULIA B NORMAN
Title or Position: CFO
Credential:
Phone: 336-679-2041