1912091315 NPI number — JAN H HATTINGH CPO

Table of content: JAN H HATTINGH CPO (NPI 1912091315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912091315 NPI number — JAN H HATTINGH CPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATTINGH
Provider First Name:
JAN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPO
Provider Gender Code:
M

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:
1912091315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44115 WOODBRIGE PARKWAY
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-445-3390
Provider Business Mailing Address Fax Number:
571-445-3392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44115 WOODBRIGE PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-445-3390
Provider Business Practice Location Address Fax Number:
571-445-3392
Provider Enumeration Date:
10/03/2006

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: 1744P3200X , with the licence number:  PS00000014 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9036963 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com