1770508442 NPI number — MCV ASSOCIATED PHYSICIANS

Table of content: (NPI 1770508442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770508442 NPI number — MCV ASSOCIATED PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCV ASSOCIATED PHYSICIANS
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:
MCV PHYSICIANS
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:
1770508442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 E MARSHALL STREET
Provider Second Line Business Mailing Address:
ANESTHESIOLOGY C03042
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23298-0510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-828-8707
Provider Business Mailing Address Fax Number:
807-828-8765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 E MARSHALL STREET
Provider Second Line Business Practice Location Address:
ANESTHESIOLOGY C03042
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23298-0510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-828-8707
Provider Business Practice Location Address Fax Number:
807-828-8765
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOUCHENS
Authorized Official First Name:
EVELYN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR MEDICAL STAFF SERVICES
Authorized Official Telephone Number:
804-828-8707

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5734371 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".