1184788457 NPI number — DR CLIFFORD ROFFIS AND ASSOCIATES ODPC

Table of content: (NPI 1184788457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184788457 NPI number — DR CLIFFORD ROFFIS AND ASSOCIATES ODPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR CLIFFORD ROFFIS AND ASSOCIATES ODPC
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:
1184788457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4811 S LABURNUM AVE
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:
23231-2713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-226-1144
Provider Business Mailing Address Fax Number:
804-236-9026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4811 S LABURNUM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23231-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-226-1144
Provider Business Practice Location Address Fax Number:
804-236-9026
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROFFIS
Authorized Official First Name:
CLIFFORD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
804-226-1144

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618000234 , 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: DA5536 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 106770 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 465284 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 34796 . This is a "DAVIS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: T21362 . This is a "RAILROAD MEDICARE UPIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: VA1073 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 276556 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 314973 . This is a "ALLIANCE PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9205403 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00063025 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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