1790116341 NPI number — ASSOCIATED SPECIALISTS, INC

Table of content: (NPI 1790116341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790116341 NPI number — ASSOCIATED SPECIALISTS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED SPECIALISTS, 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:
1790116341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
527 MEDICAL PARK DR STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26330-9009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-933-3800
Provider Business Mailing Address Fax Number:
304-933-3815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 MEDICAL PARK DR STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26330-9009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-933-3800
Provider Business Practice Location Address Fax Number:
304-933-3815
Provider Enumeration Date:
12/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
POWELL
Authorized Official First Name:
LORI
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
304-933-3800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  55-0532650 , 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: 0092785001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810022789 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810023280 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0076674000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0128388000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810023284 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810023285 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2006875000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0080399000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810016091 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0640002000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810000654 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810023454 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com