=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225340748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABOVE AND BEYOND ENTERPRISES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2010
-----------------------------------------------------
Last Update Date | 07/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2704 JEFFERSON DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-531-2039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2704 JEFFERSON DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-531-2039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. CLAUDIA GREEN JAMES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-531-2039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------