1588755813 NPI number — DOMINGO G JAVIER MD INC

Table of content: (NPI 1588755813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588755813 NPI number — DOMINGO G JAVIER MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOMINGO G JAVIER MD 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:
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:
1588755813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24701-1701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-325-5755
Provider Business Mailing Address Fax Number:
304-323-1639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24701-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-325-5755
Provider Business Practice Location Address Fax Number:
304-323-1639
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAVIER
Authorized Official First Name:
DOMINGO
Authorized Official Middle Name:
GONZALES
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
304-325-5755

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0472131 . This is a "UMWA-FUNDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0127512000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7350431 . This is a "VA MED ASSIS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: V000267 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 062480 . This is a "B/C/ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 851 945 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1022384 . This is a "WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4454937 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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