1174668594 NPI number — AHMED D FAHEEM

Table of content: (NPI 1174668594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174668594 NPI number — AHMED D FAHEEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHMED D FAHEEM
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:
APPALACHIAN PSYCHIATRIC SERVICES
Provider Other Organization Name Type Code:
3
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:
1174668594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1014 JOHNSTOWN RD
Provider Second Line Business Mailing Address:
PO BOX 1128
Provider Business Mailing Address City Name:
BECKLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25802-1128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-252-4433
Provider Business Mailing Address Fax Number:
304-252-1703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1014 JOHNSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25802-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-252-4433
Provider Business Practice Location Address Fax Number:
304-252-1703
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FAHEEM
Authorized Official First Name:
AHMED
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-252-4433

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1262 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: 436 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103T00000X , with the licence number: 829 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103T00000X , with the licence number: 541 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084P0800X , with the licence number: 12885 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084P0800X , with the licence number: 19588 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 3810004530 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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