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General NPI Number Information
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NPI Number | 1164619532
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Entity Type | Organization
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Legal Business Name | RICHLANDS HEALTHCARE, P.C.
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 350 WILMINGTON STREET
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City | RICHLANDS
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State | NC
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Zip | 28574
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Country | US
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Telephone | 910-324-1291
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Fax |
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Provider Business Mailing Address
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Address Line | 2087 CATHERINE LAKE RD
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City | RICHLANDS
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State | NC
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Zip | 28574-8122
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Country | US
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Telephone | 910-324-3125
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | WILLIAM ROBERT CANUPP
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Credential |
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Telephone | 910-324-3125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 101857
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License Number State | NC
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