1689310732 NPI number — ATKINSON COUNTY BOARD OF COMMISSIONERS

Table of content: (NPI 1689310732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689310732 NPI number — ATKINSON COUNTY BOARD OF COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATKINSON COUNTY BOARD OF COMMISSIONERS
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:
1689310732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
892 NEW CASTLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIPPERY ROCK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16057-4228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-280-5974
Provider Business Mailing Address Fax Number:
724-234-4703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 AUSTIN AVE, WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARSON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31642-3952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-422-4602
Provider Business Practice Location Address Fax Number:
724-243-4703
Provider Enumeration Date:
05/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
912-422-4602

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q184240001 . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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