1447284633 NPI number — STAGGERS, HEARE, & WHITEMAN, P.A.

Table of content: (NPI 1447284633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447284633 NPI number — STAGGERS, HEARE, & WHITEMAN, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAGGERS, HEARE, & WHITEMAN, P.A.
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:
1447284633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 N TORNADO WAY STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEYSER
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26726-6006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-788-7816
Provider Business Mailing Address Fax Number:
304-788-7863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 N TORNADO WAY STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEYSER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26726-6006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-788-7816
Provider Business Practice Location Address Fax Number:
304-788-7863
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
301-729-3485

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001739581 . This is a "MT. STATE BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810003741 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 222830 . This is a "MAMSI/UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: S986ST . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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