1093967416 NPI number — IT'S ABOUT TIME, INC

Table of content: (NPI 1093967416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093967416 NPI number — IT'S ABOUT TIME, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IT'S ABOUT TIME, 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:
1093967416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 S JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24016-4953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-206-2367
Provider Business Mailing Address Fax Number:
540-226-7640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1316 S JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24016-4953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-206-2367
Provider Business Practice Location Address Fax Number:
540-226-7640
Provider Enumeration Date:
10/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TUCK
Authorized Official First Name:
MITZI
Authorized Official Middle Name:
JAYNE
Authorized Official Title or Position:
CEO/ OWNER
Authorized Official Telephone Number:
540-206-2367

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  1113-02-006 , 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)