1477681823 NPI number — INSTITUTE OF ADVANCED ENT SURGERY LLC

Table of content: (NPI 1477681823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477681823 NPI number — INSTITUTE OF ADVANCED ENT SURGERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE OF ADVANCED ENT SURGERY LLC
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477681823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 PUMP RD
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23233-3539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-747-7427
Provider Business Mailing Address Fax Number:
804-747-7429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 PUMP RD
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23233-3539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-747-7427
Provider Business Practice Location Address Fax Number:
804-747-7429
Provider Enumeration Date:
02/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
804-237-7760

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1477681823 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".