1033108857 NPI number — ABINGDON FAMILY PRACTICE PC

Table of content: (NPI 1033108857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033108857 NPI number — ABINGDON FAMILY PRACTICE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABINGDON FAMILY PRACTICE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033108857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
617 CAMPUS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABINGDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24210-9700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-628-1186
Provider Business Mailing Address Fax Number:
276-628-8507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
617 CAMPUS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABINGDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24210-9700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-628-1186
Provider Business Practice Location Address Fax Number:
276-628-8507
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PENNINGS
Authorized Official First Name:
SIMON
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
276-628-1186

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005607531 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5752880001 . This is a "MEDICARE NCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005641802 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005642507 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 064411 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5603067 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2102748 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 460464 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5756306 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: C03006 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 226900 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3054602 . This is a "BLUE CLASSIE" identifier . This identifiers is of the category "OTHER".




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