1184720278 NPI number — BODY REPAIRS, LLC

Table of content: (NPI 1184720278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184720278 NPI number — BODY REPAIRS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BODY REPAIRS, LLC
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:
BODY REPAIRS, LLC
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:
1184720278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7263
Provider Second Line Business Mailing Address:
2800 MATHEWS STREET
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21218-0263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-243-9200
Provider Business Mailing Address Fax Number:
410-243-9290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 MATHEWS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-4449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-243-9200
Provider Business Practice Location Address Fax Number:
410-243-9290
Provider Enumeration Date:
09/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FORD
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-243-9200

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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