1952501397 NPI number — F. L. PONCE, MD, INC.

Table of content: (NPI 1952501397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952501397 NPI number — F. L. PONCE, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
F. L. PONCE, MD, 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:
FRANCISCO L. PONCE, MD
Provider Other Organization Name Type Code:
5
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:
1952501397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 18TH ST
Provider Second Line Business Mailing Address:
SUITE 213
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26101-3231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-428-3381
Provider Business Mailing Address Fax Number:
304-428-0145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 18TH ST
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-428-3381
Provider Business Practice Location Address Fax Number:
304-428-0145
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PONCE
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-428-3381

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0402013 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0130728000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700948064 . This is a "NPI TYPE I" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com