1164604922 NPI number — E MARILYNN FELTNER

Table of content: (NPI 1164604922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164604922 NPI number — E MARILYNN FELTNER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E MARILYNN FELTNER
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:
1164604922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 183
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENOVA
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25530-0183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-453-5458
Provider Business Mailing Address Fax Number:
304-453-5459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 POPLAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENOVA
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25530-1339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-453-5458
Provider Business Practice Location Address Fax Number:
304-453-5459
Provider Enumeration Date:
12/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FELTNER
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
MARILYNN
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
304-453-5458

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100007240 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2102034-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00026316 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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