1831902915 NPI number — ST. AUGUSTIN HEALTHCARE SERVICES L.L.C

Table of content: AMY BRADLEY COOK CRNP (NPI 1932223484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831902915 NPI number — ST. AUGUSTIN HEALTHCARE SERVICES L.L.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. AUGUSTIN HEALTHCARE SERVICES L.L.C
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:
1831902915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 RICHMOND HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22305-3044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-872-6598
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9105 JOUSTING LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER MARLBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20772-4388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-872-6598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2025

Additional Information

Authorized Official

Authorized Official Last Name:
NDUM
Authorized Official First Name:
BASIL
Authorized Official Middle Name:
TEGHEN
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
240-872-6598

Provider Taxonomy Codes

  • Taxonomy code: 163WG0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com