1194891846 NPI number — ORTHOPAEDIC CENTER OF THE VIRGINIAS PHYSICAL THERAPY INC.

Table of content: (NPI 1194891846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194891846 NPI number — ORTHOPAEDIC CENTER OF THE VIRGINIAS PHYSICAL THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC CENTER OF THE VIRGINIAS PHYSICAL THERAPY INC.
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:
1194891846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 COURTHOUSE RD
Provider Second Line Business Mailing Address:
SUITE #3
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24740-2421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-425-9857
Provider Business Mailing Address Fax Number:
304-487-3152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 COURTHOUSE RD
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-425-9857
Provider Business Practice Location Address Fax Number:
304-487-3152
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERSINGER LOVERN
Authorized Official First Name:
LORI
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER PRES
Authorized Official Telephone Number:
304-425-9857

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 072404 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1405075 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4502834 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0156090000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151508800 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001721163 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 270675 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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