1528269248 NPI number — COUNTY OF PRESTON BOARD OF HEALTH

Table of content: (NPI 1528269248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528269248 NPI number — COUNTY OF PRESTON BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF PRESTON BOARD OF HEALTH
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:
1528269248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 W MAIN ST
Provider Second Line Business Mailing Address:
UNIT 203
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26537-1131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-329-0096
Provider Business Mailing Address Fax Number:
304-329-3103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 W MAIN ST
Provider Second Line Business Practice Location Address:
UNIT 203
Provider Business Practice Location Address City Name:
KINGWOOD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26537-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-329-0096
Provider Business Practice Location Address Fax Number:
304-329-3103
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONLEY
Authorized Official First Name:
FREDRICK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
304-329-0096

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0021461003 . This is a "FAMILY PLANNING" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0021461000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0021461001 . This is a "RFTS" identifier . This identifiers is of the category "OTHER".




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