1902970593 NPI number — CITY OF ALEXANDRIA

Table of content: MRS. MARIANNE S. SHIRLEY PT (NPI 1184872319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902970593 NPI number — CITY OF ALEXANDRIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF ALEXANDRIA
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:
1902970593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34769
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:
22334-0769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-746-5253
Provider Business Mailing Address Fax Number:
703-838-5093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SECOND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22314-1348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-746-5253
Provider Business Practice Location Address Fax Number:
703-838-5093
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARMER
Authorized Official First Name:
LAROSA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
FISCAL OFFICER I
Authorized Official Telephone Number:
703-746-5253

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009014471 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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