1265606974 NPI number — DAVID A. MULLINS, MD PLLC

Table of content: (NPI 1265606974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265606974 NPI number — DAVID A. MULLINS, MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID A. MULLINS, MD PLLC
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:
1265606974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1392
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24740-1392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-425-1852
Provider Business Mailing Address Fax Number:
304-431-3756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 12TH STREET EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-425-1852
Provider Business Practice Location Address Fax Number:
304-431-3756
Provider Enumeration Date:
04/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MULLINS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-425-1852

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X , with the licence number:  19244 , 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: 0048144000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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