1194872242 NPI number — ABINGDON PHYSICIAN PARTNERS (DBA) EAR, NOSE AND THROAT SPECIALTY CENTE

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 1194872242 NPI number — ABINGDON PHYSICIAN PARTNERS (DBA) EAR, NOSE AND THROAT SPECIALTY CENTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABINGDON PHYSICIAN PARTNERS (DBA) EAR, NOSE AND THROAT SPECIALTY CENTE
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:
EAR NOSE AND THROAT SPECIALTY CENTER
Provider Other Organization Name Type Code:
3
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:
1194872242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16000 JOHNSTON MEMORIAL DR
Provider Second Line Business Mailing Address:
SUITE 312
Provider Business Mailing Address City Name:
ABINGDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24211-7659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-258-3730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16000 JOHNSTON MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
ABINGDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24211-7659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-258-3730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PELTZER
Authorized Official First Name:
LETICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER IN PRACTICE
Authorized Official Telephone Number:
276-258-3730

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com