1245288208 NPI number — STEVE A SIVERD CPO

Table of content: STEVE A SIVERD CPO (NPI 1245288208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245288208 NPI number — STEVE A SIVERD CPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIVERD
Provider First Name:
STEVE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPO
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:
1245288208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 NETWORK STA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-3851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-892-5300
Provider Business Mailing Address Fax Number:
757-892-5303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 NETWORK STA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-3851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-892-5300
Provider Business Practice Location Address Fax Number:
757-892-5303
Provider Enumeration Date:
05/04/2006

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: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 434534 . This is a "BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 194379 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1029129 . This is a "ACM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 542040443 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9190414 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39563 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7703398 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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