1114973831 NPI number — JANET M FORD C.R.N.A.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114973831 NPI number — JANET M FORD C.R.N.A.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

FORD

Provider First Name:

JANET

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

C.R.N.A.

Provider Gender Code:

F

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:

1114973831

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/30/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 897

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MORGANTOWN

Provider Business Mailing Address State Name:

WV

Provider Business Mailing Address Postal Code:

26507-0897

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

304-293-7401

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

101 STADIUM DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MORGANTOWN

Provider Business Practice Location Address State Name:

WV

Provider Business Practice Location Address Postal Code:

26506-7911

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

304-598-4000

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

05/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 367500000X , with the licence number:  021424 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 27005299701 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 001706470 . This is a "MSBCBS GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: P00229270 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 0138176 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 486800700 . This is a "FEDERAL EMPLOYEES" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 74011040 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 001720732 . This is a "MOUNTAIN STATE BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 0067756000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 1045406 . This is a "BRICKSTREET INDIVIDUAL" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 148321800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 270052997004 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 0207026000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: DA0096 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".