1124009667 NPI number — DR. WILLIAM SUKOVICH MD

Table of content: DR. WILLIAM SUKOVICH MD (NPI 1124009667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124009667 NPI number — DR. WILLIAM SUKOVICH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUKOVICH
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1124009667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 PETER JEFFERSON PKWY
Provider Second Line Business Mailing Address:
STE 170
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22911-8835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-977-3001
Provider Business Mailing Address Fax Number:
434-977-3002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 PETER JEFFERSON PKWY
Provider Second Line Business Practice Location Address:
STE 170
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22911-8835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-977-3001
Provider Business Practice Location Address Fax Number:
434-977-3002
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  0101238298 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010240573 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10003995 . This is a "COMMUNITY HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 415564 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00285406 . This is a "MEDICARE PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00285406 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 188897 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 738220 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10003995 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188897 . This is a "ANTHEM/HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1219881 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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