1295723195 NPI number — THOMAS G. POWELL, INC.

Table of content: (NPI 1295723195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295723195 NPI number — THOMAS G. POWELL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS G. POWELL, 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:
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:
1295723195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2034 DABNEY RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230-3361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-649-9043
Provider Business Mailing Address Fax Number:
804-783-8212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2034 DABNEY RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-649-9043
Provider Business Practice Location Address Fax Number:
804-783-8212
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MONTEIRO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
CORP SEC. TREASURER
Authorized Official Telephone Number:
804-649-9043

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0004385092 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009190082 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87 . This is a "CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 148785100 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9190082 . This is a "VIRGINIA PREMEIR HP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 63730 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: AN01 . This is a "AMERICAN CHOICE HP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2056388 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 252386 . This is a "MDPIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 82-00022 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009130004 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 062896 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 51951 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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