Provider Demographics
NPI:1255659512
Name:CAH ACQUISITION COMPANY 10 LLC
Entity Type:Organization
Organization Name:CAH ACQUISITION COMPANY 10 LLC
Other - Org Name:YADKIN VALLEY COMMUNITY PHYSCIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-2041
Mailing Address - Street 1:1100 MAIN ST STE 2350
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-5186
Mailing Address - Country:US
Mailing Address - Phone:336-679-2041
Mailing Address - Fax:336-679-6717
Practice Address - Street 1:624 W MAIN ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7804
Practice Address - Country:US
Practice Address - Phone:336-679-2041
Practice Address - Fax:336-679-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012JYMedicaid
NC34-1308Medicare PIN