1538320163 NPI number — WILLIAM W TOWNSEND OD PC

Table of content: (NPI 1538320163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538320163 NPI number — WILLIAM W TOWNSEND OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM W TOWNSEND OD PC
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:
1538320163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4224 HOLLAND ROAD
Provider Second Line Business Mailing Address:
108
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-463-0000
Provider Business Mailing Address Fax Number:
757-631-0260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4224 HOLLAND ROAD
Provider Second Line Business Practice Location Address:
108
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-463-0000
Provider Business Practice Location Address Fax Number:
757-631-0260
Provider Enumeration Date:
06/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TOWNSEND
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
WALLACE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
757-463-0000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618000189 , 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)

  • Identifier: 009203001 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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