1720227598 NPI number — MR. CHRISTOPHER A SURBER M.A., L.P.C.

Table of content: MR. CHRISTOPHER A SURBER M.A., L.P.C. (NPI 1720227598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720227598 NPI number — MR. CHRISTOPHER A SURBER M.A., L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SURBER
Provider First Name:
CHRISTOPHER
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.P.C.
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:
1720227598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2585 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25703-1642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-697-1396
Provider Business Mailing Address Fax Number:
304-697-2086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 MARION PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COAL GROVE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45638-3165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-532-1188
Provider Business Practice Location Address Fax Number:
740-532-1183
Provider Enumeration Date:
02/18/2009

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 1717 , 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)





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