1609952423 NPI number — MED-RESPONSE, INC.

Table of content: (NPI 1609952423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609952423 NPI number — MED-RESPONSE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED-RESPONSE, INC.
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:
1609952423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24701-8225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 HONAKER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-487-9073
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARKE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-915-0054

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  018764 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 018764 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 018764 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 018764 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1377485 . This is a "UMWA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 050572 . This is a "ANTHEM" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 048211200 . This is a "DEPT OF LABOR" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000212913 . This is a "MT STATE BC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: V003083 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0146817001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com