1093855892 NPI number — GLASS AND HENRY PC

Table of content: (NPI 1093855892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093855892 NPI number — GLASS AND HENRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLASS AND HENRY PC
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:
6
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:
1093855892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 S INDEPENDENCE BLVD
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-1150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-497-4965
Provider Business Mailing Address Fax Number:
757-497-4197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 S INDEPENDENCE BLVD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-497-4965
Provider Business Practice Location Address Fax Number:
757-497-4197
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY HENRY
Authorized Official First Name:
MARY ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-497-4965

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904003282 , 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: A000899 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 344120 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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