1174602775 NPI number — DR. ROLAND W MEFFERT D.C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174602775 NPI number — DR. ROLAND W MEFFERT D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEFFERT
Provider First Name:
ROLAND
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.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:
1174602775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
803 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NITRO
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25143-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-755-4111
Provider Business Mailing Address Fax Number:
304-755-4131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
803 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NITRO
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25143-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-755-4111
Provider Business Practice Location Address Fax Number:
304-755-4131
Provider Enumeration Date:
11/03/2006

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: 111N00000X , with the licence number:  627 , 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: 001710718 . This is a "BCBS ID NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 296509 . This is a "MAMSI ID NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0132066000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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