Blueh IV Health Services PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

BLUEH IV HEALTH SERVICES PLLC

Practice address

9625 David Taylor Dr
Charlotte, NC 28262-2362

Phone

(704) 942-8281

Fax

(352) 554-5073

NPI assigned

Aug 14, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

La Toya Dawson

Title

Billing Director

Phone

(352) 231-7551

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600646400000",
    "number": "1134730864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 GRANDEUR RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282693217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9625 DAVID TAYLOR DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282622362",
            "telephone_number": "704-942-8281",
            "fax_number": "352-554-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEH IV HEALTH SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-14",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "LA TOYA",
        "authorized_official_title_or_position": "BILLING DIRECTOR",
        "authorized_official_telephone_number": "352-231-7551"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336556414",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• General Practice Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.