1629248521 NPI number — TELAMON CORPORATION

Table of content: (NPI 1629248521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629248521 NPI number — TELAMON CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TELAMON CORPORATION
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:
1629248521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3937 WESTERN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27606-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-239-8115
Provider Business Mailing Address Fax Number:
919-851-1139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 W SIOUX LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROMNEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26757-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-822-4514
Provider Business Practice Location Address Fax Number:
304-822-4515
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CROOKE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
919-239-8115

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810001509 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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