1558365171 NPI number — DAVID P ALLEN DO

Table of content: DAVID P ALLEN DO (NPI 1558365171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558365171 NPI number — DAVID P ALLEN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
DAVID
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1558365171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
200 POCAHONTAS TRAIL
Provider Business Mailing Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24986-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-536-5030
Provider Business Mailing Address Fax Number:
304-536-5031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 MAIN ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
RAINELLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25962-1253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-438-8561
Provider Business Practice Location Address Fax Number:
304-438-6754
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  696 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 0102050099 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0049368000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558365171 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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