1811326796 NPI number — BLUE CAB OF MARTINSBURG LLC

Table of content: AIKATERINA GALEOS MS, RDN, CSG (NPI 1386033363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811326796 NPI number — BLUE CAB OF MARTINSBURG LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE CAB OF MARTINSBURG 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:
Provider Other Organization Name Type Code:
6
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:
1811326796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 BAKER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-5035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-323-0123
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 W. RACE STREEET UNIT #1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-323-0123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARRETT
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
KIRBY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
540-323-0123

Provider Taxonomy Codes

  • Taxonomy code: 344600000X , with the licence number:  7544 , 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)