1831154095 NPI number — MERIT MEDICAL RURAL HEALTH CLINIC-HONAKER, INC.

Table of content: JEAN M. KIM PHD (NPI 1205214194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831154095 NPI number — MERIT MEDICAL RURAL HEALTH CLINIC-HONAKER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIT MEDICAL RURAL HEALTH CLINIC-HONAKER, INC.
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:
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:
1831154095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLANDS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-964-9102
Provider Business Mailing Address Fax Number:
276-963-2865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5296 REDBUD HIGHWAY
Provider Second Line Business Practice Location Address:
BALL PROFESSIONAL BUILDING
Provider Business Practice Location Address City Name:
HONAKER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-873-6825
Provider Business Practice Location Address Fax Number:
276-873-4355
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAVED
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
276-964-9102

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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