1699196246 NPI number — HEART AND VASCULAR INSTITUTE OF VIRGINIA, INC

Table of content: (NPI 1699196246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699196246 NPI number — HEART AND VASCULAR INSTITUTE OF VIRGINIA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART AND VASCULAR INSTITUTE OF VIRGINIA, INC
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:
1699196246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22402-3339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-739-9953
Provider Business Mailing Address Fax Number:
571-659-9445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4004 GENESEE PL STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-8304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-739-9953
Provider Business Practice Location Address Fax Number:
571-659-9445
Provider Enumeration Date:
12/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CZAJKA
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
SOLE MEMBER/ OWNER
Authorized Official Telephone Number:
855-739-9953

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  0101247593 , registered in the state of VA ; 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