NPIMap

Organization Active NPI

Advance Rehabilitation and Nursing

  • Family Medicine Physician
  • Advance, NC
National Provider Identifier
1306120795
Registry record updated Oct 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9601605 Issued in NC
Legal business name
ADVANCE REHABILITATION AND NURSING
Practice address
169 Yadkin Valley Rd
Suite 101
Advance, NC 27006-8786
Phone
(336) 940-2659
NPI assigned
Oct 4, 2011
Last updated
Oct 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2011

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

Authorized official

Name
Dr. Walter A Ezeigbo, MD
Title
Ceo
Phone
(336) 940-2659

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9601605 NC Primary

Addresses

Primary practice location

169 Yadkin Valley Rd
Suite 101
Advance, NC 27006-8786

Mailing address

5515 Fresh Field LN
Winston Salem, NC 27106-6262
Phone (336) 940-2659

National Provider Directory

National Provider Directory

Locations

169 Yadkin Valley Rd
Ste 101
Advance, NC 27006
Phone (336) 940-2659

316 NC Highway 801 S
Advance, NC 27006
Phone (336) 998-0240

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1317686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317686400000",
    "number": "1306120795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5515 FRESH FIELD LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271066262",
            "telephone_number": "336-940-2659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 YADKIN VALLEY RD",
            "address_2": "SUITE 101",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270068786",
            "telephone_number": "336-940-2659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE REHABILITATION AND NURSING",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-04",
        "last_updated": "2011-10-04",
        "status": "A",
        "authorized_official_last_name": "EZEIGBO",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-940-2659",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9601605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Advance, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; 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.