1104360296 NPI number — MR. STERLING PRICE TRAVIS M.ED., N.C.C.

Table of content: MR. STERLING PRICE TRAVIS M.ED., N.C.C. (NPI 1104360296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104360296 NPI number — MR. STERLING PRICE TRAVIS M.ED., N.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAVIS
Provider First Name:
STERLING
Provider Middle Name:
PRICE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., N.C.C.
Provider Gender Code:
M

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:
1104360296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6744 HOPTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-2970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-989-8952
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8249 CROWN COLONY PKWY # VA23116
Provider Second Line Business Practice Location Address:
PKWY #200
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23116-4057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-789-1224
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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