1639367402 NPI number — JEFFERSON COUNTY SCHOOLS

Table of content: (NPI 1639367402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639367402 NPI number — JEFFERSON COUNTY SCHOOLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON COUNTY SCHOOLS
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:
1639367402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 S. COLLEGE ST.
Provider Second Line Business Mailing Address:
RESA VIII
Provider Business Mailing Address City Name:
MARTINSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-267-3595
Provider Business Mailing Address Fax Number:
304-267-3599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 MORDINGTON AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLES TOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25414-0987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-725-9741
Provider Business Practice Location Address Fax Number:
304-267-3599
Provider Enumeration Date:
10/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MEDICAID COORDINTOR
Authorized Official Telephone Number:
304-267-3595

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: 0012254000 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".