1891573572 NPI number — MR. BRIAN ANTHONY SIGMAN ATC,LAT

Table of content: MR. BRIAN ANTHONY SIGMAN ATC,LAT (NPI 1891573572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891573572 NPI number — MR. BRIAN ANTHONY SIGMAN ATC,LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIGMAN
Provider First Name:
BRIAN
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC,LAT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIGMAN
Provider Other First Name:
BRIAN
Provider Other Middle Name:
ANTHONY
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC,LAT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891573572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 MERCY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURRICANE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25526-1462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-539-0624
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3350 TEAYS VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURRICANE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25526-8605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-539-0624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT0001130362 , 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)





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