Provider Demographics
NPI:1073205837
Name:MYSUPPORT
Entity Type:Organization
Organization Name:MYSUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPSS
Authorized Official - Phone:252-339-0864
Mailing Address - Street 1:4509 FAIR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-5941
Mailing Address - Country:US
Mailing Address - Phone:252-339-0864
Mailing Address - Fax:
Practice Address - Street 1:1100 ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-1317
Practice Address - Country:US
Practice Address - Phone:252-339-0864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty