1417930553 NPI number — MEDICAL SERVICES OF AMERICA INC

Table of content: (NPI 1417930553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417930553 NPI number — MEDICAL SERVICES OF AMERICA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL SERVICES OF AMERICA 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:
1417930553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1928
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29071-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-957-0500
Provider Business Mailing Address Fax Number:
888-342-6190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1109 BROOKDALE ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
MARTINSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24112-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-666-9800
Provider Business Practice Location Address Fax Number:
276-666-9861
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFCOAT
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
803-957-0500

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7705035 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9107410 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com