1710084884 NPI number — ATHENA A HOWARD MD PC

Table of content: (NPI 1710084884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710084884 NPI number — ATHENA A HOWARD MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHENA A HOWARD MD PC
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:
1710084884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24015-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-344-9779
Provider Business Mailing Address Fax Number:
540-344-7154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 RANDOLPH ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
RADFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24141-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-731-1600
Provider Business Practice Location Address Fax Number:
540-731-0720
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
ATHENA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-731-1600

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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