1386723583 NPI number — TRAHOS MEDICAL ENTERPRISES PLLC

Table of content: (NPI 1386723583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386723583 NPI number — TRAHOS MEDICAL ENTERPRISES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRAHOS MEDICAL ENTERPRISES 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:
MICHAEL C TRAHOS DO
Provider Other Organization Name Type Code:
4
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:
1386723583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 OSAGE STREET
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22302-2611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-998-4913
Provider Business Mailing Address Fax Number:
703-931-8171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1707 OSAGE ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22302-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-998-4913
Provider Business Practice Location Address Fax Number:
703-931-8171
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRAHOS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
703-998-4913

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0102035626 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QA0505X , with the licence number: 0102035626 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X , with the licence number: 0102035626 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 010201021 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 144441 . This is a "SOUTHERN HEALTH SERV. INC." identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 470178 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 976064 . This is a "MAILHANDLERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1433740 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2138371 . This is a "UNITED HEALTHCARE/ONE NET PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4088139 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8138371 . This is a "MDIPA/OPTIMUM CHOICE HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8857-0001 . This is a "BC/BS OF NATIONAL CAPITAL AREA" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 182247 . This is a "ANTHEM BC/BS OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 503495 . This is a "UNICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 280953 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com