1285659789 NPI number — ALEXANDRIA SPORTS, INC.

Table of content: (NPI 1285659789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285659789 NPI number — ALEXANDRIA SPORTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEXANDRIA SPORTS, INC.
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:
PATRIOT SPORTSMEDICINE
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:
1285659789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4714 GETTYSBURG RD
Provider Second Line Business Mailing Address:
LEGAL DEPT
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17055-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-975-4510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6035 BURKE CENTRE PKWY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BURKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22015-3750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-978-3300
Provider Business Practice Location Address Fax Number:
703-978-6216
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TARVIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VICE PRESIDENT & SECRETARY
Authorized Official Telephone Number:
717-972-1132

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 496646 , issued by the state of ( VA ) . This identifiers is of the category "MEDICARE OSCAR/CERTIFICATION".