1588812549 NPI number — RUNK AND PRATT OF FOREST

Table of content: (NPI 1588812549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588812549 NPI number — RUNK AND PRATT OF FOREST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUNK AND PRATT OF FOREST
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:
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:
1588812549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 GRISTMILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24551-2604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-385-8506
Provider Business Mailing Address Fax Number:
434-385-6678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 GRISTMILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24551-2604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-385-8506
Provider Business Practice Location Address Fax Number:
434-385-6678
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RUNK
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
434-237-2268

Provider Taxonomy Codes

  • Taxonomy code: 311500000X , with the licence number:  RO-08129 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0102578751 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com