1659949055 NPI number — SPERO HEALTH OF WEST VIRGINIA, LLC

Table of content: (NPI 1659949055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659949055 NPI number — SPERO HEALTH OF WEST VIRGINIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPERO HEALTH OF WEST VIRGINIA, 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:
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:
1659949055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 FRANKLIN RD STE 430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-1602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-265-0371
Provider Business Mailing Address Fax Number:
615-844-9033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 ROSEBUD PLZ STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26301-9823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-265-0371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
DULANY
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
615-265-0371

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com