1508277021 NPI number — 4 GUYZ LLC

Table of content: (NPI 1508277021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508277021 NPI number — 4 GUYZ LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
4 GUYZ LLC
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:
1508277021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17548 VETERANS MEMORIAL HWY
Provider Second Line Business Mailing Address:
SUITE P
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26537-9797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-329-6979
Provider Business Mailing Address Fax Number:
304-329-6631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17548 VETERANS MEMORIAL HWY
Provider Second Line Business Practice Location Address:
SUITE P
Provider Business Practice Location Address City Name:
KINGWOOD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26537-9797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-329-6979
Provider Business Practice Location Address Fax Number:
304-329-6631
Provider Enumeration Date:
05/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LEMASTERS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
304-329-6979

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: SP0552486 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2145810 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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