1588627970 NPI number — DR. JOHN PORTER RICHARDS D.O.

Table of content: JENNIFER ANN YESSA-KAST MSSW (NPI 1619933496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588627970 NPI number — DR. JOHN PORTER RICHARDS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDS
Provider First Name:
JOHN
Provider Middle Name:
PORTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1588627970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4710 CHIMNEY DR STE H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25302-4841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-935-2513
Provider Business Mailing Address Fax Number:
304-935-2524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4710 CHIMNEY DR STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25302-4841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-935-2513
Provider Business Practice Location Address Fax Number:
304-935-2524
Provider Enumeration Date:
04/08/2006

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:  1129 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: 1129 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110028670 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 224826100 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 550694936 . This is a "UNITED HEALTHCARE MAMSI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 004361690 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0041905000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1025208 . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 205562 . This is a "CARELINK COVENTRY" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001721126 . This is a "BC/BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7152313 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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