1497712756 NPI number — HAMPTON ROADS PATHOLOGY INC

Table of content: (NPI 1497712756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497712756 NPI number — HAMPTON ROADS PATHOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMPTON ROADS PATHOLOGY INC
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:
1497712756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1295
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24701-1295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-323-4320
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 BATTLEFIELD BLVD N
Provider Second Line Business Practice Location Address:
CHESAPEAKE GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-312-8121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JACOB
Authorized Official First Name:
LIONEL
Authorized Official Middle Name:
NEWMAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-312-8121

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890179J , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0179J . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: C03497 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".