1184865552 NPI number — VEERABHADRA CHIRRAVURI PLLC

Table of content: MS. NANCY JEAN GLASS MFT MARRIAGE AND FM (NPI 1881889541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184865552 NPI number — VEERABHADRA CHIRRAVURI PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VEERABHADRA CHIRRAVURI PLLC
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:
1184865552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1086
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42241-1086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-887-0700
Provider Business Mailing Address Fax Number:
270-885-3776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 COOL WATER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-8738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-887-0700
Provider Business Practice Location Address Fax Number:
270-885-3776
Provider Enumeration Date:
03/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHIRRAVURI
Authorized Official First Name:
VEERABHADRA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/SOLE MEMBER
Authorized Official Telephone Number:
270-887-0700

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35171 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00958 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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