1114936234 NPI number — DR. RANDALL FLEMING HAWKINS MD

Table of content: DR. RANDALL FLEMING HAWKINS MD (NPI 1114936234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114936234 NPI number — DR. RANDALL FLEMING HAWKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWKINS
Provider First Name:
RANDALL
Provider Middle Name:
FLEMING
Provider Name Prefix Text:
DR.
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:
1114936234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 VALLEY DRIVE
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
POINT PLEASANT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25550-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-675-7700
Provider Business Mailing Address Fax Number:
304-675-6510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 VALLEY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
POINT PLEASANT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25550-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-675-7700
Provider Business Practice Location Address Fax Number:
304-675-6510
Provider Enumeration Date:
08/07/2006

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:  16211 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 69109 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0072981000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0796714 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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