1043883143 NPI number — PROVERBS MEDICAL AND HEALTH CLINIC, LLC

Table of content: (NPI 1043883143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043883143 NPI number — PROVERBS MEDICAL AND HEALTH CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVERBS MEDICAL AND HEALTH CLINIC, 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:
1043883143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1128 LOCKETT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541-4050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-203-2593
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 ARNETT BLVD STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24540-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-314-6136
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
VICKIE
Authorized Official Middle Name:
BRANDON
Authorized Official Title or Position:
FNP/APMHCNS
Authorized Official Telephone Number:
571-314-6136

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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