1215001714 NPI number — N PAUL MORIN II MD PC

Table of content: GAYLE E MYERS MSN ANP (NPI 1447220728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215001714 NPI number — N PAUL MORIN II MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
N PAUL MORIN II MD PC
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:
6
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:
1215001714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1995 WEST RIDGE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYTHEVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-223-1983
Provider Business Mailing Address Fax Number:
276-223-1316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1995 WEST RIDGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYTHEVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-223-1983
Provider Business Practice Location Address Fax Number:
276-223-1316
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORIN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
TABOR
Authorized Official Title or Position:
SEC TREAS CFO
Authorized Official Telephone Number:
276-223-1983

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH9430 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 246183 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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