1174586325 NPI number — DANIEL OWENS PH.D. P.C.

Table of content: (NPI 1174586325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174586325 NPI number — DANIEL OWENS PH.D. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL OWENS PH.D. P.C.
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:
1174586325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 ROWLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24503-2618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-845-4454
Provider Business Mailing Address Fax Number:
434-845-4299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 ROWLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24503-2618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-845-4454
Provider Business Practice Location Address Fax Number:
434-845-4299
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
434-845-4454

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810001078 , 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)

  • Identifier: 182047 . This is a "ANTHEM PROVIDER ID #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com