1295723195 NPI number — THOMAS G. POWELL, INC.

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 1295723195 NPI number — THOMAS G. POWELL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS G. POWELL, 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:
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:
1295723195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2034 DABNEY RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230-3361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-649-9043
Provider Business Mailing Address Fax Number:
804-783-8212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2034 DABNEY RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-649-9043
Provider Business Practice Location Address Fax Number:
804-783-8212
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MONTEIRO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
CORP SEC. TREASURER
Authorized Official Telephone Number:
804-649-9043

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0004385092 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009190082 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87 . This is a "CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 148785100 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9190082 . This is a "VIRGINIA PREMEIR HP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 63730 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: AN01 . This is a "AMERICAN CHOICE HP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2056388 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 252386 . This is a "MDPIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 82-00022 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009130004 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 062896 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 51951 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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