Provider Demographics
NPI:1972554186
Name:DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO
Entity type:Organization
Organization Name:DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RAYLE
Authorized Official - Last Name:HOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-295-4653
Mailing Address - Street 1:5550 77 CENTER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-0739
Mailing Address - Country:US
Mailing Address - Phone:704-295-4653
Mailing Address - Fax:704-295-4288
Practice Address - Street 1:411 BILLINGSLEY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1066
Practice Address - Country:US
Practice Address - Phone:704-347-3900
Practice Address - Fax:704-347-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890328MMedicaid
SCZAN993Medicaid
NC890328MMedicaid
NCCM0461Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA83500OtherVA BCBS
NC890328MMedicaid
NCCM0461Medicare ID - Type UnspecifiedRAILROAD MEDICARE