1700445798 NPI number — WILLIAMSON HEALTH & WELLNESS CENTER INC

Table of content: (NPI 1700445798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700445798 NPI number — WILLIAMSON HEALTH & WELLNESS CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMSON HEALTH & WELLNESS CENTER 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:
WILLIAMSON HEALTH & WELLNESS CENTER - ALDERSON CLINIC
Provider Other Organization Name Type Code:
3
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:
1700445798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2080
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25661-2080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-236-5902
Provider Business Mailing Address Fax Number:
855-487-4047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
859 ALDERSON ST STE 1000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25661-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-236-5902
Provider Business Practice Location Address Fax Number:
855-487-4047
Provider Enumeration Date:
06/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BECKETT
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
DONOVAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
304-236-5902

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com