1477751915 NPI number — ELKTON FAMILY AND CHILDRENS MEDICAL CLINIC

Table of content: (NPI 1477751915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477751915 NPI number — ELKTON FAMILY AND CHILDRENS MEDICAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELKTON FAMILY AND CHILDRENS MEDICAL CLINIC
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:
1477751915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 E ROCKINGHAM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22827-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-298-9900
Provider Business Mailing Address Fax Number:
540-298-8991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 E ROCKINGHAM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22827-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-298-9900
Provider Business Practice Location Address Fax Number:
540-298-8991
Provider Enumeration Date:
07/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
PETER
Authorized Official Middle Name:
GRAYSON
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
540-298-9900

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  0024166329 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 0024166329 , 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: 010119146 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134126626 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1477751915 . This is a "EFCMC NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5689660 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C10418 . This is a "PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0101031417 . This is a "DR STAUFFER'S VA LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1538190434 . This is a "DR. STAUFFER NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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