1730127374 NPI number — SUREFIRE HEALTH CARE PROFESSIONALS

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 1730127374 NPI number — SUREFIRE HEALTH CARE PROFESSIONALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUREFIRE HEALTH CARE PROFESSIONALS
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:
1730127374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3330 BOURBON ST
Provider Second Line Business Mailing Address:
123
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22408-7333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-361-7461
Provider Business Mailing Address Fax Number:
540-361-7462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6519 MACEDONIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22580-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-633-6563
Provider Business Practice Location Address Fax Number:
804-633-5063
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VIEIRA
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
EXECUTIVE MANAGER
Authorized Official Telephone Number:
540-361-7461

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  7016853 , 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)





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