1477571511 NPI number — DR. BRENDA JEAN RATCLIFF PH.D.

Table of content: DR. BRENDA JEAN RATCLIFF PH.D. (NPI 1477571511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477571511 NPI number — DR. BRENDA JEAN RATCLIFF PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RATCLIFF
Provider First Name:
BRENDA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAIRD
Provider Other First Name:
BRENDA
Provider Other Middle Name:
RATCLIFF
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477571511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5770 PLANK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATURAL BRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24578-4039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-529-1124
Provider Business Mailing Address Fax Number:
540-291-8339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5770 PLANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATURAL BRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24578-4039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-529-1124
Provider Business Practice Location Address Fax Number:
540-291-8339
Provider Enumeration Date:
07/17/2006

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: 103T00000X , with the licence number:  0811000003 , 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: 010001897 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11-3701532 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11-3701532 . This is a "TRICARE-CHAMPUS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 142607 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9528762 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".