Organization Active NPI

Fifth Avenue Internal Medicine and Geriatrics PA

  • Geriatric Medicine (Internal Medicine) Physician
  • Hendersonville, NC
National Provider Identifier
1417049867
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
103068 Issued in NC
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

Updated by the provider on Aug 22, 2020

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)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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

IdentifierTypeStateIssuer
8941202MedicaidNC

National Provider Directory

National Provider Directory

Locations

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.

Verify at the official NPI Registry.