Provider Demographics
NPI:1619165164
Name:FH MANGUNDAYAO & FC MANGUNDAYAO PTR
Entity Type:Organization
Organization Name:FH MANGUNDAYAO & FC MANGUNDAYAO PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANGUNDAYAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-859-2121
Mailing Address - Street 1:PO BOX 1374
Mailing Address - Street 2:292 SOUTH MAIN ST.
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239-1374
Mailing Address - Country:US
Mailing Address - Phone:336-859-2121
Mailing Address - Fax:336-859-2122
Practice Address - Street 1:292 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239-1374
Practice Address - Country:US
Practice Address - Phone:336-859-2121
Practice Address - Fax:336-859-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22000261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1619165164OtherGROUP NPI FOR MEDICARE