1184676348 NPI number — ISLE OF WIGHT CO BOARD OF SUPERVISORS

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 1184676348 NPI number — ISLE OF WIGHT CO BOARD OF SUPERVISORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISLE OF WIGHT CO BOARD OF SUPERVISORS
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:
1184676348
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:
PO BOX 61549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-355-1753
Provider Business Mailing Address Fax Number:
757-557-0936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17130 MONUMENT CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISLE OF WIGHT
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-365-6307
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASKEY
Authorized Official First Name:
W
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
COUNTY ADMINISTRATOR ISLE OF WIGHT
Authorized Official Telephone Number:
757-365-6201

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1052 , 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)





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