1669594719 NPI number — PRAXIS CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669594719 NPI number — PRAXIS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAXIS 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:
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:
1669594719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 YELLOW WOOD WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BECKLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25801-7126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-255-2376
Provider Business Mailing Address Fax Number:
304-255-7120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
454 APPALACHIAN HWY RT 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-202-0424
Provider Business Practice Location Address Fax Number:
304-732-8800
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BATES
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT PT CEO
Authorized Official Telephone Number:
304-255-2376

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1196527 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7926084 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001710560 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 371681200 . This is a "FEDERAL WORKERS COMP." identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: CI4026 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 223194 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810011548 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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