1912903501 NPI number — HOST MANAGEMENT COMPANY, INC.

Table of content: (NPI 1912903501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912903501 NPI number — HOST MANAGEMENT COMPANY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOST MANAGEMENT COMPANY, 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:
WOLF MEDICAL
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:
1912903501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1093 MEADOW BROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30188-6563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-778-2431
Provider Business Mailing Address Fax Number:
706-233-8277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1093 MEADOW BROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-6563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-778-2431
Provider Business Practice Location Address Fax Number:
706-233-8277
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COLVER
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
SINCLAIR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-778-2431

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  301083553 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000900699A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com