1538331178 NPI number — CLAY CO. DEV

Table of content: (NPI 1538331178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538331178 NPI number — CLAY CO. DEV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAY CO. DEV
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:
TENDER HEART
Provider Other Organization Name Type Code:
3
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:
1538331178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
812 NORTHSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMERSVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26651-2028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-872-9115
Provider Business Mailing Address Fax Number:
304-872-9227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 NORTHSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26651-2028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-872-9115
Provider Business Practice Location Address Fax Number:
304-872-9227
Provider Enumeration Date:
03/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OFFICE MANAGER/BILLING CLERK
Authorized Official Telephone Number:
304-872-9115

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  21874703 , 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: 33810011359 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com