1114197993 NPI number — NEW RIVER SERVICE AUTHORITY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114197993 NPI number — NEW RIVER SERVICE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW RIVER SERVICE AUTHORITY
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:
6
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:
1114197993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
895 STATE FARM RD
Provider Second Line Business Mailing Address:
SUITE 508
Provider Business Mailing Address City Name:
BOONE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28607-4917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-263-5666
Provider Business Mailing Address Fax Number:
828-262-5687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 E LEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YADKINVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27055-8132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-679-8805
Provider Business Practice Location Address Fax Number:
828-262-5687
Provider Enumeration Date:
03/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREWS
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
336-372-4095

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2329286 . This is a "MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com