1346220290 NPI number — DR. LISA M WEST M.D

Table of content: DR. LISA M WEST M.D (NPI 1346220290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346220290 NPI number — DR. LISA M WEST M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEST
Provider First Name:
LISA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLENIK WEST
Provider Other First Name:
LISA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346220290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3738 WINTERFIELD RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23113-9236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-378-9378
Provider Business Mailing Address Fax Number:
804-378-9379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3738 WINTERFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MIDLOTHIAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23113-9236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-378-9378
Provider Business Practice Location Address Fax Number:
804-378-9379
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  0101053220 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000137218904 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006205445 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 226113 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34350 . This is a "OPTIMA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541941044002 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160049261 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6205445 . This is a "VA PREMIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0970529 . This is a "AETNA USHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 328075 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34350 . This is a "SENTARA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 94542 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8785535 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11943 . This is a "CARENET" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com