1710023734 NPI number — JOHN P. RICHARDS, D.O.

Table of content: (NPI 1710023734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710023734 NPI number — JOHN P. RICHARDS, D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN P. RICHARDS, D.O.
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:
1710023734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4914 ELK RIVER RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKVIEW
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25071-9278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-965-7051
Provider Business Mailing Address Fax Number:
304-965-5074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4914 ELK RIVER RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKVIEW
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25071-9278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-965-7051
Provider Business Practice Location Address Fax Number:
304-965-5074
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-965-7051

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  1129 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 1129 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204D00000X , with the licence number: 1129 , 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: 1025208 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0041905000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205562 . This is a "CARELINK COVENTRY" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7152313 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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