NPIMap

Organization Active NPI

Owen Drive Surgical Clinic, PA

  • Surgery Physician
  • Fayetteville, NC
National Provider Identifier
1922104066
Registry record updated Oct 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
OWEN DRIVE SURGICAL CLINIC, PA
Practice address
1617 Owen Dr
Fayetteville, NC 28304-3425
Phone
(910) 484-0101
Fax
(910) 484-2563
NPI assigned
Sep 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2009

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

Authorized official

Name
Debi Chaudhuri, MD
Title
President
Phone
(910) 484-0101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1617 Owen Dr
Fayetteville, NC 28304-3425

Mailing address

PO Box 1615
Etowah, NC 28729-1615
Phone (910) 484-0101

Other identifiers 2

IdentifierTypeStateIssuer
89-0255AMedicaidNC
0255AOtherNCBCBS

National Provider Directory

National Provider Directory

Locations

1607 Owen Dr
Fayetteville, NC 28304

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254873600000",
    "number": "1922104066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1615",
            "city": "ETOWAH",
            "state": "NC",
            "postal_code": "287291615",
            "telephone_number": "910-484-0101",
            "fax_number": "910-484-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043425",
            "telephone_number": "910-484-0101",
            "fax_number": "910-484-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OWEN DRIVE SURGICAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2009-10-07",
        "status": "A",
        "authorized_official_last_name": "CHAUDHURI",
        "authorized_official_first_name": "DEBI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-484-0101",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89-0255A",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0255A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.

Verify at the official NPI Registry.