1982607933 NPI number — ADR LLC

Table of content: (NPI 1982607933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982607933 NPI number — ADR LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
ADR LLC
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:
1982607933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 808
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21501-0808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-724-1646
Provider Business Mailing Address Fax Number:
301-724-7429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
952 SETON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-1950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-777-3522
Provider Business Practice Location Address Fax Number:
301-777-1902
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
JONG
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-724-1646

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0201927000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA5555 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001586989 . This is a "MT ST BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 403741300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: J249 . This is a "MD BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 216A . This is a "MD BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".