1710324363 NPI number — NEUROTECH, NA INC.

Table of content: (NPI 1710324363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710324363 NPI number — NEUROTECH, NA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROTECH, NA 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:
1710324363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11220 ASSETT LOOP
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-762-1005
Provider Business Mailing Address Fax Number:
571-762-1005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11220 ASSETT LOOP
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-980-1197
Provider Business Practice Location Address Fax Number:
888-980-1195
Provider Enumeration Date:
05/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BURKE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
571-762-1005

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 269428 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300001916 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03325521 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1710324363 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200143800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3694762 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100458560 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000142686 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145146400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1710324363 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1710324363 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM1578 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003185108A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1032476680001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1710324363 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3003397 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108207100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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