1780776187 NPI number — ANATOMICAL DESIGNS, INC.

Table of content: (NPI 1780776187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780776187 NPI number — ANATOMICAL DESIGNS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANATOMICAL DESIGNS, INC.
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:
1780776187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
383 DIXON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401-3967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-430-1470
Provider Business Mailing Address Fax Number:
724-430-1472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 MURDOCH AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-3248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-485-1345
Provider Business Practice Location Address Fax Number:
304-485-0906
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIME
Authorized Official First Name:
SHANDON
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
800-418-0313

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25181274600 . This is a "WV WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 251812746001 . This is a "ACCORDIA/PEIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: DME746 . This is a "THE HEALTH PLAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: UNISYS , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251812746 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001704954 . This is a "MT. STATE BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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