1750654059 NPI number — MS. VIRGINIA M BOTHWELL CRNA, DNAP

Table of content: MS. VIRGINIA M BOTHWELL CRNA, DNAP (NPI 1750654059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750654059 NPI number — MS. VIRGINIA M BOTHWELL CRNA, DNAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOTHWELL
Provider First Name:
VIRGINIA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA, DNAP
Provider Gender Code:
F

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:
1750654059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5151 REED RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43220-2553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-457-2306
Provider Business Mailing Address Fax Number:
614-884-0776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 REED RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43220-2553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-457-2306
Provider Business Practice Location Address Fax Number:
614-884-0776
Provider Enumeration Date:
02/16/2012

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: 367500000X , with the licence number:  AC001005 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: APRN9445785 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: COA 14479-NA , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01209409 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0085436 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105146200 . 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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