1710090014 NPI number — BOTETOURT COUNTY BOARD OF SUPERVISORS

Table of content: (NPI 1710090014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710090014 NPI number — BOTETOURT COUNTY BOARD OF SUPERVISORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOTETOURT COUNTY BOARD OF SUPERVISORS
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:
1710090014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4750 HEMPSTEAD STATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-875-0136
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 N ROANOKE ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FINCASTLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24090-3018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-473-8401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FIRESTONE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
EMERGENCY SERVICES SPECIALIST
Authorized Official Telephone Number:
540-473-8401

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1128 , 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: 010234107 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 181780 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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