1770014268 NPI number — PELUMI BADMUS INS. AGENCY, LLC

Table of content: (NPI 1770014268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770014268 NPI number — PELUMI BADMUS INS. AGENCY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PELUMI BADMUS INS. AGENCY, LLC
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:
VOGUE ASSURANCE
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:
1770014268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 558
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LUIS REY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92068-0558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-400-8461
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 L STREET, NW
Provider Second Line Business Practice Location Address:
( R.H TERRELL RECREATION CENTER)
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-400-8461
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
OLUKOTUN
Authorized Official First Name:
OLUWAPELUMI
Authorized Official Middle Name:
Authorized Official Title or Position:
CERTIFIED CASE MANAGER
Authorized Official Telephone Number:
571-400-8461

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  4217575 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 4217575 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251T00000X , with the licence number: 4217575 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X , with the licence number: 4217575 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305S00000X , with the licence number: 4217575 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 4217575 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347C00000X , with the licence number: 4217575 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 999999999999 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 999999999999 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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