1306056825 NPI number — NEW RIVER VALLEY PODIATRY & FOOT SURGERY PC

Table of content: (NPI 1306056825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306056825 NPI number — NEW RIVER VALLEY PODIATRY & FOOT SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW RIVER VALLEY PODIATRY & FOOT SURGERY 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:
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:
1306056825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 PROFESSIONAL PARK DR SE
Provider Second Line Business Mailing Address:
STE 13
Provider Business Mailing Address City Name:
BLACKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24060-6680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-951-3338
Provider Business Mailing Address Fax Number:
340-951-1738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 PROFESSIONAL PARK DR SE
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
BLACKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24060-6680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-951-3338
Provider Business Practice Location Address Fax Number:
340-951-1738
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEREDITH
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
340-951-3338

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CI1132 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com