1891713269 NPI number — DR. CONNIE PERKINS DO

Table of content: DR. CONNIE PERKINS DO (NPI 1891713269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891713269 NPI number — DR. CONNIE PERKINS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS
Provider First Name:
CONNIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1891713269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320 MAPLEWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RONCEVERTE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24970-8016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1322 MAPLEWOOD AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RONCEVERTE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24970-8016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-647-1161
Provider Business Practice Location Address Fax Number:
304-647-3006
Provider Enumeration Date:
07/17/2006

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: 207V00000X , with the licence number:  1710 , 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)

  • Identifier: 5472643 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 649678001 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 035 . This is a "MTST BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 119357 . This is a "ANTHEM BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 160046203 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 114262 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 273677 . This is a "MAMSI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 6200073000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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