1295916047 NPI number — BRYAN W. DANHIRES, DPM PLLC

Table of content: (NPI 1295916047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295916047 NPI number — BRYAN W. DANHIRES, DPM PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRYAN W. DANHIRES, DPM 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:
THE FOOT AND ANKLE CENTER OF CLARKSBURG
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:
1295916047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 BUCKHANNON PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26301-3947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-623-1991
Provider Business Mailing Address Fax Number:
304-622-6824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 BUCKHANNON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26301-3947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-623-1991
Provider Business Practice Location Address Fax Number:
304-622-6824
Provider Enumeration Date:
11/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DANHIRES
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-623-1991

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  WV 000371 , 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: BR9341401 . This is a "MEDICARE GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: DB0339 . This is a "MCRRRB" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2102035000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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