1790739985 NPI number — AMERIRAD INC

Table of content: (NPI 1790739985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790739985 NPI number — AMERIRAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIRAD 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:
1790739985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1645
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26507-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-598-2291
Provider Business Mailing Address Fax Number:
304-598-2293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 J D ANDERSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-598-2291
Provider Business Practice Location Address Fax Number:
304-598-2293
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURTON
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-598-2291

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  NA , 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: DE3255 . This is a "RAILROAD MC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2650701 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810001884 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 601168805 . This is a "US DEPT. OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 601168805 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 001706151 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 101375266 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20460200 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000365372 . This is a "BCBSOH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 601168800 . This is a "US DEPT. OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: DC1733 . This is a "RAILROAD MC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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