=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184792368
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUREKA A RIGBY PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 07/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2721 X RAY DR
-----------------------------------------------------
City | GASTONIA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28054-7491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-874-2255
-----------------------------------------------------
Fax | 704-810-7417
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 E SECOND AVE
-----------------------------------------------------
City | GASTONIA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28052-4358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-874-1904
-----------------------------------------------------
Fax | 704-867-2134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 104149
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------