1245409127 NPI number — MARION COUNTY BOARD OF EDUCATION

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 1245409127 NPI number — MARION COUNTY BOARD OF EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION COUNTY BOARD OF EDUCATION
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:
1245409127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 GASTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRMONT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26554-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-624-6554
Provider Business Mailing Address Fax Number:
304-624-5223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 GASTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26554-2739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-624-6554
Provider Business Practice Location Address Fax Number:
304-624-5223
Provider Enumeration Date:
02/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
SUEQ
Authorized Official Title or Position:
RESA VII MEDICAID COORDINATOR
Authorized Official Telephone Number:
304-624-6554

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4803040000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com