1245206820 NPI number — MR. JOHN ANDREW KONA M.D.,

Table of content: MICHELLE BLACKLOCK (NPI 1548741861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245206820 NPI number — MR. JOHN ANDREW KONA M.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONA
Provider First Name:
JOHN
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,
Provider Gender Code:
M

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:
1245206820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 927
Provider Second Line Business Mailing Address:
5 E ALVON ROAD, SUITE 7
Provider Business Mailing Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
23901-2373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-536-5030
Provider Business Mailing Address Fax Number:
304-536-5031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23901-1199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-392-8811
Provider Business Practice Location Address Fax Number:
434-392-7654
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204C00000X , with the licence number:  28246 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 0101036194 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 309283 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 345614 . This is a "ANTHEM BCBS (FARMVILLE)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 62791 . This is a "MAMSI PROVIDER ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: POOO26558 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 134PE . This is a "STATE OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1245206820 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1425298 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 161669037 . This is a "TAX ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 014542S53 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 345614 . This is a "ANTHEM HEALTH KEEPERS (FARMVILLE)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4131313 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 55036 . This is a "SENTARA PROVIDER ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 134PE . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 345614 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 465999 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89134PE , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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