1114434024 NPI number — EVELYN SUE SADLER PCA

Table of content: EVELYN SUE SADLER PCA (NPI 1114434024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114434024 NPI number — EVELYN SUE SADLER PCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADLER
Provider First Name:
EVELYN
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
EVELYN
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114434024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 HERITAGE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAWKEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-356-4562
Provider Business Mailing Address Fax Number:
304-558-4563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 HERITAGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAWKEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-524-7227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2018

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: 3747P1801X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810009159 . This is a "PROVIDER ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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