1942396908 NPI number — WIGGINGTON ROAD FAMILY PRACTICE INC

Table of content: (NPI 1942396908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942396908 NPI number — WIGGINGTON ROAD FAMILY PRACTICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WIGGINGTON ROAD FAMILY PRACTICE 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:
1942396908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 WIGGINGTON ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-385-7578
Provider Business Mailing Address Fax Number:
434-385-9756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 WIGGINGTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-385-7578
Provider Business Practice Location Address Fax Number:
434-385-9756
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PODOSEH
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
434-385-7578

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1205921210 . This is a "INDIVIDUAL NPI CHRISTIAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5642876 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 249893 . This is a "ANTHEM BCBS CHRISTIAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 012828 . This is a "ANTHEM FOR ALAN PODOSEK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1205851581 . This is a "INDIV NPI ALAN PODOSEK,MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356366645 . This is a "INDIV NPI HARB RANK, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010386250 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 214335 . This is a "ANTHEM FOR HARB RANK, MD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5674808 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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