1437135530 NPI number — DR. GEORGE PULLIN MD

Table of content: DR. GEORGE PULLIN MD (NPI 1437135530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437135530 NPI number — DR. GEORGE PULLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PULLIN
Provider First Name:
GEORGE
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:
1437135530
Entity Type Code:
Individual
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:
4750 HEMPSTEAD STATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-875-0136
Provider Business Mailing Address Fax Number:
937-619-4342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 MACCORKLE AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25304-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-388-4170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2005

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: 207P00000X , with the licence number:  17363 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0076738000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010267714 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001718047 . This is a "WV BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00307763 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001718047 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 930125094 . This is a "CH1 RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1053520 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1053520 . This is a "WV DWC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 930125095 . This is a "CH2 RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00300482 . This is a "PR1 RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".