1477842763 NPI number — CHARLES B TWIGG

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477842763 NPI number — CHARLES B TWIGG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES B TWIGG
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:
6
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:
1477842763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERRYVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22611-1340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-955-5051
Provider Business Mailing Address Fax Number:
540-955-5052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERRYVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22611-1340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-955-5051
Provider Business Practice Location Address Fax Number:
540-955-5052
Provider Enumeration Date:
04/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TWIGG
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
BAYLISS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
540-955-5051

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  0618000137 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 0618000137 , 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: 6502970001 . This is a "DME NSC PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9232397 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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