1922143338 NPI number — INHOME MEDICATIONS WV, INC

Table of content: (NPI 1922143338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922143338 NPI number — INHOME MEDICATIONS WV, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INHOME MEDICATIONS WV, INC
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:
1922143338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 S PRESTON ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
RANSON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25438-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-725-3509
Provider Business Mailing Address Fax Number:
304-728-6946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S PRESTON ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
RANSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25438-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-725-3509
Provider Business Practice Location Address Fax Number:
304-728-6946
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
PATTY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
386-698-3737

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  021400228 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 138694741 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9115871 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2011174 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000293603 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0141491000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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