1649251695 NPI number — MICHAEL K HASKETT OD PC

Table of content: (NPI 1649251695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649251695 NPI number — MICHAEL K HASKETT OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL K HASKETT OD PC
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:
1649251695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHASE CITY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23924-1609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-372-2701
Provider Business Mailing Address Fax Number:
434-372-3355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHASE CITY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23924-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-372-2701
Provider Business Practice Location Address Fax Number:
434-372-3355
Provider Enumeration Date:
11/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HASKETT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
434-372-2701

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618000062 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 063596 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 410038621 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009206019 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".