1003891813 NPI number — STEVEN R FRELIER MD

Table of content: STEVEN R FRELIER MD (NPI 1003891813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003891813 NPI number — STEVEN R FRELIER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRELIER
Provider First Name:
STEVEN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1003891813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 CLAREMONT CT
Provider Second Line Business Mailing Address:
SUITE 213
Provider Business Mailing Address City Name:
COLONIAL HEIGHTS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23834-1770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-520-2626
Provider Business Mailing Address Fax Number:
804-520-0626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 CLAREMONT CT
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834-1770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-520-2626
Provider Business Practice Location Address Fax Number:
804-520-0626
Provider Enumeration Date:
12/14/2005

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: 207R00000X , with the licence number:  4301069282 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 0101244352 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104316121 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003891813 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003891813 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003894813 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1105100311 . This is a "BC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com