1669476057 NPI number — MRS. STEPHANIE L HAMILTON PAC

Table of content: MRS. STEPHANIE L HAMILTON PAC (NPI 1669476057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669476057 NPI number — MRS. STEPHANIE L HAMILTON PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
STEPHANIE
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOWDY
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669476057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 DAWKINS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24901-9302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-647-4411
Provider Business Mailing Address Fax Number:
304-793-2270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 BROOKSHIRE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-6761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-647-6559
Provider Business Practice Location Address Fax Number:
304-793-2270
Provider Enumeration Date:
06/13/2005

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: 363A00000X , with the licence number:  280 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 01040 , 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: 562370581 . This is a "SELECT NET (ACCORDIA)" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com