1104981976 NPI number — TARAS TECHNIQUES, LLC

Table of content: (NPI 1104981976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104981976 NPI number — TARAS TECHNIQUES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TARAS TECHNIQUES, LLC
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:
TARAS TECHNIQUES HEALTH CARE SERVICES
Provider Other Organization Name Type Code:
5
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:
1104981976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 684
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20156-0684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-636-4123
Provider Business Mailing Address Fax Number:
703-636-4123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10432 BALLS FORD RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20109-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-636-4123
Provider Business Practice Location Address Fax Number:
703-636-4123
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAGGIO
Authorized Official First Name:
TARAS
Authorized Official Middle Name:
NK
Authorized Official Title or Position:
MANAGING PRINCIPAL DIRECTOR
Authorized Official Telephone Number:
703-636-4123

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7823829 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7111860 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7929865 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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