Mutiat B Bamgbala, PROVIDER
Individual provider Active NPI Private Vehicle · Lexington, NC
NPI 1205528635 · NPPES record last updated Oct 6, 2023
Key facts
- NPI
- 1205528635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Private Vehicle 347C00000X
- License
- 000048761695 (NC)
- Practice address
- 254 Ashfield LN
Lexington, NC 27292-8348 - Phone
- (860) 986-0003
- NPI assigned
- May 24, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000048761695 | NC | MD | Private Vehicle |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mutty Group Home | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Transportation Network Company | 342000000X | 000048761695 | NC | |
| Private Vehicle | 347C00000X | 000048761695 | NC | Yes |
Addresses
Primary practice location
254 Ashfield LN
Lexington, NC 27292-8348
Mailing address
355 Faith Rd
Salisbury, NC 28146-7007
Phone (860) 986-0003
Other providers in Lexington, NC
- Melissa Stephanie Ayala
- Mary Jo Ayllon
- Chasity Rose Bailey
- Susan Desiree Bailey
- James Harlie Baldwin Jr.
- Tony Banjoko
- Antonio Banner
- Erricka Baremore
- Barium Springs
- Dylan Wayne Barkley
All providers in Lexington, NC · Private Vehicle in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.