1598800930 NPI number — DUANE ZOBRIST GROUP LLC

Table of content: SHYLA BERNICE CABELL LCSWA, LCASA (NPI 1821693680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598800930 NPI number — DUANE ZOBRIST GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUANE ZOBRIST GROUP LLC
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:
1598800930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 365
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-536-1193
Provider Business Mailing Address Fax Number:
304-536-4490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 E MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24986-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-536-1193
Provider Business Practice Location Address Fax Number:
304-536-4490
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HONAKER
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MEDICAL TRANSPORT MANAGER
Authorized Official Telephone Number:
304-536-1193

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  01540614 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810007034 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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