1033291695 NPI number — THE FAMILY PRACTICE OF DR. GEORGE M. PITTMAN PLLC

Table of content: (NPI 1033291695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033291695 NPI number — THE FAMILY PRACTICE OF DR. GEORGE M. PITTMAN PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE FAMILY PRACTICE OF DR. GEORGE M. PITTMAN PLLC
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:
1033291695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3486
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-7486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-402-5403
Provider Business Mailing Address Fax Number:
800-518-9245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3190 IRVINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-9031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-369-0070
Provider Business Practice Location Address Fax Number:
859-369-0073
Provider Enumeration Date:
10/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PITTMAN
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
859-369-0070

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  32608 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000351815 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1518 . This is a "BC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00222112 . This is a "RRMC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 18D0946970 . This is a "CLIA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0100012 . This is a "UHC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".