1720093693 NPI number — DRS. SODERQUIST & WEIS, P. C.

Table of content: (NPI 1720093693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720093693 NPI number — DRS. SODERQUIST & WEIS, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. SODERQUIST & WEIS, P. C.
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:
1720093693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 E JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22902-5353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-971-9601
Provider Business Mailing Address Fax Number:
434-971-9646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22902-5353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-971-9601
Provider Business Practice Location Address Fax Number:
434-971-9646
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURRUSS
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
434-971-9601

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  S4157/ W8596 , 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)

  • Identifier: 9178262 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9178339 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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