1093891665 NPI number — BARR-THORN ENTERPRISES, INC.

Table of content: (NPI 1093891665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093891665 NPI number — BARR-THORN ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARR-THORN ENTERPRISES, 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:
NOVA PHARMACY DIABETES CARE & EDUCATION
Provider Other Organization Name Type Code:
3
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:
1093891665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2048
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRUNDY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24614-2048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-935-4777
Provider Business Mailing Address Fax Number:
276-935-2269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 S MAYO TRL STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-432-2274
Provider Business Practice Location Address Fax Number:
606-433-9816
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THORNBURY
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PIC/VP
Authorized Official Telephone Number:
606-432-6959

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  9101535 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 90003021 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 1145660002 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: P06583 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X , with the licence number: 02140000551 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000239278 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 842863 . This is a "ASSOC. OF DIABETES CARE & EDUCATION SERVICES (ADCES)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9101535 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P06583 . This is a "STATE LIC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 90003021 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149093800 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1826544 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54001151 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08500509 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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