1326350026 NPI number — DAVID KEITH MERRIFIELD CSA

Table of content: DAVID KEITH MERRIFIELD CSA (NPI 1326350026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326350026 NPI number — DAVID KEITH MERRIFIELD CSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRIFIELD
Provider First Name:
DAVID
Provider Middle Name:
KEITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSA
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:
1326350026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10825
Provider Second Line Business Mailing Address:
CONTANT 11-3KB, STT, VI 00802
Provider Business Mailing Address City Name:
CHARLOTTE AMALIE
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00801-3825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-998-3084
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CONTANT 11-3KB
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-774-3003
Provider Business Practice Location Address Fax Number:
340-776-3029
Provider Enumeration Date:
07/09/2010

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: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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