1629011226 NPI number — WILLIAM R POLHAMUS P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629011226 NPI number — WILLIAM R POLHAMUS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLHAMUS
Provider First Name:
WILLIAM
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1629011226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1115 BOULDERS PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NORTH CHESTERFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23225-4067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-560-5595
Provider Business Mailing Address Fax Number:
804-560-9029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 JOHNSTON WILLIS DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23235-4765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-379-8088
Provider Business Practice Location Address Fax Number:
804-794-6067
Provider Enumeration Date:
06/13/2006

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: 363AS0400X , with the licence number:  0110001563 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0110001563 , 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: 0536798 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 287174 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "CORVEL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008947104 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540885859 . This is a "C&O EMPLOYEE'S HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0900325 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 31213 . This is a "SH CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "MULTIPLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 100679 . This is a "ANTHEM HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "FOCUS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "COMPMANAGEMENT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00011038 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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