Active NPI
Fifth Avenue Internal Medicine and Geriatrics PA
- Geriatric Medicine (Internal Medicine) Physician
- Hendersonville, NC
National Provider Identifier
1417049867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 103068
- Legal business name
- FIFTH AVENUE INTERNAL MEDICINE AND GERIATRICS PA
- Practice address
- 724 Fifth Avenue West
Hendersonville, NC 28739 - Phone
- (828) 693-6566
- Fax
- (828) 693-6765
- NPI assigned
- Sep 29, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Phillip M Klein
- Title
- Office Manager
- Phone
- (828) 693-6566
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 103068 | NC | Primary |
Addresses
Primary practice location
724 Fifth Avenue West
Hendersonville, NC 28739
Mailing address
724 Fifth Avenue West
Hendersonville, NC 28739
Phone (828) 693-6566
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8941202 | Medicaid | NC |
National Provider Directory
National Provider DirectoryLocations
724 5th Ave W
Hendersonvlle, NC 28739
Phone (828) 693-6566
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1417049867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "724 FIFTH AVENUE WEST",
"city": "HENDERSONVILLE",
"state": "NC",
"postal_code": "28739",
"telephone_number": "828-693-6566",
"fax_number": "828-693-6765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "724 FIFTH AVENUE WEST",
"city": "HENDERSONVILLE",
"state": "NC",
"postal_code": "28739",
"telephone_number": "828-693-6566",
"fax_number": "828-693-6765"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FIFTH AVENUE INTERNAL MEDICINE AND GERIATRICS PA",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-29",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "KLEIN",
"authorized_official_first_name": "PHILLIP",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "828-693-6566",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "NC",
"license": "103068",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8941202",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Hendersonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.