1295868784 NPI number — PRESSLEY RIDGE

Table of content: MADELINE BARRETT DAVIS MA (NPI 1790576320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295868784 NPI number — PRESSLEY RIDGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESSLEY RIDGE
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:
1295868784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 MARSHALL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15214-3016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-321-6995
Provider Business Mailing Address Fax Number:
412-321-7008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-3733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-291-6148
Provider Business Practice Location Address Fax Number:
304-296-9562
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLAIR
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
SR ACCOUNTING DIRECTOR
Authorized Official Telephone Number:
412-321-6995

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9435008000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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