1508948191 NPI number — EDUARDO ALFREDO RIVAS - PARDO M.D.

Table of content: EDUARDO ALFREDO RIVAS - PARDO M.D. (NPI 1508948191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508948191 NPI number — EDUARDO ALFREDO RIVAS - PARDO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVAS - PARDO
Provider First Name:
EDUARDO
Provider Middle Name:
ALFREDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1508948191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 714960
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43271-4960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-322-1808
Provider Business Mailing Address Fax Number:
205-322-1851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 HAL GREER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-322-1808
Provider Business Practice Location Address Fax Number:
205-322-1851
Provider Enumeration Date:
10/20/2006

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: 207L00000X , with the licence number:  12809 , 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: 001720969 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0775399 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00249933 . This is a "PALMETTO GBA-RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1027242 . This is a "WORKERS' COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0057987000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64697931 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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