Table of content for ADR LLC
(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) | : | |
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| Provider Organization Name (Legal Business Name) | : | ADR LLC |
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| Provider Last Name (Legal Name) | : | |
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| Provider First Name | : | |
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| Provider Middle Name | : | |
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| Provider Name Prefix Text | : | |
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| Provider Name Suffix Text | : | |
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| Provider Credential Text | : | |
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| Provider Gender Code | : | |
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Provider's Other Name Information
| Provider Other Organization Name | : | |
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| Provider Other Organization Name Type Code | : | |
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| Provider Other Last Name | : | |
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| Provider Other First Name | : | |
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| Provider Other Middle Name | : | |
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| Provider Other Name Prefix Text | : | |
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| Provider Other Name Suffix Text | : | |
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| Provider Other Credential Text | : | |
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| Provider Other Last Name Type Code | : | |
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NPI Number Information
| NPI Number | : | 1982607933 |
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| Entity Type Code | : | Organization |
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| Replacement NPI | : | |
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| Last Update Date | : | 01/28/2008 |
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| NPI Deactivation Reason Code | : | |
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| NPI Deactivation Date | : | |
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| NPI Reactivation Date | : | |
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Provider's Business Mailing Address
| Provider First Line Business Mailing Address | : | PO BOX 808 |
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| Provider Second Line Business Mailing Address | : | |
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| Provider Business Mailing Address City Name | : | CUMBERLAND |
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| Provider Business Mailing Address State Name | : | MD |
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| Provider Business Mailing Address Postal Code | : | 215010808 |
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| Provider Business Mailing Address Country Code | : | US |
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| Provider Business Mailing Address Telephone Number | : | 3017241646 |
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| Provider Business Mailing Address Fax Number | : | 3017247429 |
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Provider's Practice Location Mailing Address
| Provider First Line Business Practice Location Address | : | 952 SETON DR |
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| Provider Second Line Business Practice Location Address | : | |
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| Provider Business Practice Location Address City Name | : | CUMBERLAND |
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| Provider Business Practice Location Address State Name | : | MD |
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| Provider Business Practice Location Address Postal Code | : | 215021950 |
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| Provider Business Practice Location Address Country Code | : | US |
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| Provider Business Practice Location Address Telephone Number | : | 3017773522 |
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| Provider Business Practice Location Address Fax Number | : | 3017771902 |
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| Provider Enumeration Date | : | 05/23/2005 |
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Authorized Official
| Authorized Official Last Name | : | KIM |
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| Authorized Official First Name | : | JONG |
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| Authorized Official Middle Name | : | K |
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| Authorized Official Title or Position | : | PRESIDENT |
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| Authorized Official Telephone Number | : | 3017241646 |
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Provider Taxonomy Codes
- Taxonomy code: 174400000X
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Other Provider's Identifiers (legacy, non-NPI)
- Identifier: 0201927000
, issued by the state of ( WV )
.
This identifiers is of the category "".
- Identifier: 216A
. This is a "MD BLUE SHIELD" identifier
, issued by the state of ( MD )
.
This identifiers is of the category "".
- Identifier: DA5555
. This is a "RAILROAD MEDICARE" identifier
.
This identifiers is of the category "".
- Identifier: 762M
, issued by the state of ( MD )
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This identifiers is of the category "".
- Identifier: 762M
, issued by the state of ( MD )
.
This identifiers is of the category "".
- Identifier: DA5555
.
This identifiers is of the category "".
- Identifier: J249
. This is a "MD BLUE SHIELD" identifier
, issued by the state of ( MD )
.
This identifiers is of the category "".
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