1609867266 NPI number — DR. AARON J PRUSSIN M.D.

Table of content: DR. AARON J PRUSSIN M.D. (NPI 1609867266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609867266 NPI number — DR. AARON J PRUSSIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRUSSIN
Provider First Name:
AARON
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1609867266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 S. 500 E
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84102-1971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-587-6336
Provider Business Mailing Address Fax Number:
801-715-8228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 DAVIS ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BLACKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24060-7010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-381-0344
Provider Business Practice Location Address Fax Number:
540-381-1462
Provider Enumeration Date:
11/02/2005

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: 207YX0007X , with the licence number:  0101051964 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: FP5290337 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 006500111 . This is a "VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000460 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 018759S56 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 127380 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: A2283 . This is a "MEDCOST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C09521 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 6566060005 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541982275 . This is a "JOHN DEERE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 140176 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C06556 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1609867266 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 332829 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541982275 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5860049 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C06637 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006500111 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140176 . This is a "VIRGINIA HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".