1588742464 NPI number — MS. VERONICA A MAGUIRE OTR

Table of content: MS. VERONICA A MAGUIRE OTR (NPI 1588742464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588742464 NPI number — MS. VERONICA A MAGUIRE OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGUIRE
Provider First Name:
VERONICA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

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:
1588742464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2258 WRIGHTSBORO ROAD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-724-6543
Provider Business Mailing Address Fax Number:
206-350-9023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2258 WRIGHTSBORO ROAD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-724-6543
Provider Business Practice Location Address Fax Number:
206-350-9023
Provider Enumeration Date:
11/01/2006

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: 225X00000X , with the licence number:  OT000285 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10065244 . This is a "AMERIGROUP ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000581567B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 312248 . This is a "WELLCARE PROVIDER #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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