1336499771 NPI number — WYCHOCK CONSTRUCTION

Table of content: (NPI 1336499771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336499771 NPI number — WYCHOCK CONSTRUCTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYCHOCK CONSTRUCTION
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:
1336499771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5711 UP A WAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22407-6749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-604-3195
Provider Business Mailing Address Fax Number:
540-518-9213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5711 UP A WAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22407-6749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-604-3195
Provider Business Practice Location Address Fax Number:
540-518-9213
Provider Enumeration Date:
09/13/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WYCHOCK
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
540-604-3195

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X , with the licence number:  2705119134 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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