1750379376 NPI number — DR. GEOFFREY R COUSINS MD

Table of content: DR. GEOFFREY R COUSINS MD (NPI 1750379376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750379376 NPI number — DR. GEOFFREY R COUSINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUSINS
Provider First Name:
GEOFFREY
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1750379376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88
Provider Second Line Business Mailing Address:
200 POCAHONTAS TRAIL
Provider Business Mailing Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24986-0088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-536-5030
Provider Business Mailing Address Fax Number:
304-536-5031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2828 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25702-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-399-7530
Provider Business Practice Location Address Fax Number:
304-399-7532
Provider Enumeration Date:
10/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  WV21957 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810003749 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2927622 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001766919 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com