1467444075 NPI number — MR. WILLIAM LUVERNE LITTLE JR. DO

Table of content: MR. WILLIAM LUVERNE LITTLE JR. DO (NPI 1467444075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467444075 NPI number — MR. WILLIAM LUVERNE LITTLE JR. DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITTLE
Provider First Name:
WILLIAM
Provider Middle Name:
LUVERNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1467444075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1558 CHERRY GROVE RD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23432-1822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-255-2488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3315 HIGH ST
Provider Second Line Business Practice Location Address:
THE CENTER FOR PAIN MANAGEMENT
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23707-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-399-0759
Provider Business Practice Location Address Fax Number:
757-397-8951
Provider Enumeration Date:
08/19/2005

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: 207LP2900X , with the licence number:  0102050102 , 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: 2000373 . This is a "VIRGINIA PHYSICIAN NETWOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 265202 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "VIRGINIA HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150684200 . This is a "OWCP FED WC VIA ACS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "FOCUS WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "MIDATLANTIC HEALTH SOLUTI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7906181 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: A1797 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050068527 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10010979 . This is a "SENTARA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "CORVEL WC PROVIDER NETWOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "BENESIGHT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5714931 . This is a "PREMIER HEALTH PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: Q50102 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2890302001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5714931 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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