1831483601 NPI number — ACUPUNCTURE & WELLNESS LLC

Table of content: (NPI 1831483601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831483601 NPI number — ACUPUNCTURE & WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACUPUNCTURE & WELLNESS 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:
1831483601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5550 STERRETT PL
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-2611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-997-0390
Provider Business Mailing Address Fax Number:
410-885-4744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 STERRETT PL
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-997-0390
Provider Business Practice Location Address Fax Number:
410-885-4744
Provider Enumeration Date:
06/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
SEOK
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC DIRECTOR/OWNER
Authorized Official Telephone Number:
410-997-0390

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  U01592 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 551510600 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: C7VJS 92173902 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: Y300-0001 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com