1942263934 NPI number — DR. HEATHER B PEARMAN DPM

Table of content: (NPI 1447462510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942263934 NPI number — DR. HEATHER B PEARMAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARMAN
Provider First Name:
HEATHER
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1942263934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 W MONROE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYTHEVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24382-2240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-228-2212
Provider Business Mailing Address Fax Number:
276-228-7835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 W MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYTHEVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24382-2240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-228-2212
Provider Business Practice Location Address Fax Number:
276-228-7835
Provider Enumeration Date:
04/10/2006

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: 213ES0103X , with the licence number:  0103300845 , 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: 009304312 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3461634 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009304304 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 291938 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 480032504 . This is a "RR MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009304339 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141669 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 101910 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009304321 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383973 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 383972 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5442037 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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