1780625137 NPI number — LORI M PEAK PT

Table of content: LORI M PEAK PT (NPI 1780625137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780625137 NPI number — LORI M PEAK PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEAK
Provider First Name:
LORI
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1780625137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOYD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24091-3750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-745-5005
Provider Business Mailing Address Fax Number:
540-745-5004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 S LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOYD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24091-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-745-5005
Provider Business Practice Location Address Fax Number:
540-745-5004
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305005662 , 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: 284203 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 137660 . This is a "BC/BS ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2429864 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2281002 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 364553080 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00194716 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: TN0100 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7559448 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com