1891825360 NPI number — MASTERWORKS INC

Table of content: (NPI 1891825360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891825360 NPI number — MASTERWORKS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASTERWORKS INC
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:
1891825360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 767
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANIELS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25832-0767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-573-6858
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 BROOK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANIELS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25832-9693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-573-6858
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SYVERTSON
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
304-573-6858

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0001489 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 87316 . This is a "UNICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 9420008-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1064530 . This is a "WORKERSCOMP/BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 612406500 . This is a "DOL FECA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001706475 . This is a "MSBCBS- GROUP PIN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001714553 . This is a "MSBCBS- GREGORY SYVERTSON" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: M134278 . This is a "INTEGRATED HEALTH PLAN INC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 5534228 . This is a "FIRST HEALTH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 697891 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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