1760660096 NPI number — ANTOINETTE D. ADAMS, DPM, PC

Table of content: (NPI 1760660096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760660096 NPI number — ANTOINETTE D. ADAMS, DPM, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTOINETTE D. ADAMS, DPM, 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:
ADAMS COMPREHENSIVE FOOT CARE
Provider Other Organization Name Type Code:
3
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:
1760660096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMPORIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23847-0306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-336-9001
Provider Business Mailing Address Fax Number:
434-336-9229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 BAKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23847-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-336-9001
Provider Business Practice Location Address Fax Number:
434-336-9229
Provider Enumeration Date:
02/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
ANTOINETTE
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
434-336-9001

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0103300897 , 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: 010008221 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146796 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3724957 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 33691 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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