Active NPI
Mark Elno Archambault, PA-C
- Medical Physician Assistant
- Winston Salem, NC
National Provider Identifier
1881825917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 0010-01083
- Practice address
- Department of Physician Assistant Studies
Medical Center Blvd
Winston Salem, NC 27157-1006 - Phone
- (336) 716-2028
- Fax
- (336) 716-4432
- NPI assigned
- Aug 6, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0010-01083 | NC | Primary |
Addresses
Primary practice location
Department of Physician Assistant Studies
Medical Center Blvd
Winston Salem, NC 27157-1006
Mailing address
Department of Physician Assistant Studies
Medical Center Blvd
Winston Salem, NC 27157-1006
Phone (336) 716-2028
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-01083 | NC | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249516800000",
"number": "1881825917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPARTMENT OF PHYSICIAN ASSISTANT STUDIES",
"address_2": "MEDICAL CENTER BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271571006",
"telephone_number": "336-716-2028",
"fax_number": "336-716-4432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "DEPARTMENT OF PHYSICIAN ASSISTANT STUDIES",
"address_2": "MEDICAL CENTER BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271571006",
"telephone_number": "336-716-2028",
"fax_number": "336-716-4432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARCHAMBAULT",
"first_name": "MARK",
"middle_name": "ELNO",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-08-06",
"last_updated": "2009-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NC",
"license": "0010-01083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
- Arbor Acres United Methodist Retirement Community, Inc
- Arbor Care Solutions LLC
- Jennifer Marie Arbuckle, MA, CCC-SLP
- Arch & Sparrow Counseling PLLC
- Arch Angel'S Enterrises II, LLC
- Archangels Transit Inc
- Bridget Wallace Archer, RPH
- Leearlis Archie, CNA, MAA
- Melody Sherrell Archie
- Michael Edward Arcuri, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.