1972548618 NPI number — JEFFERY F ADDISON MD

Table of content: JEFFERY F ADDISON MD (NPI 1972548618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972548618 NPI number — JEFFERY F ADDISON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADDISON
Provider First Name:
JEFFERY
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1972548618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
331 LAIDLEY ST STE 307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25301-1605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-208-1414
Provider Business Mailing Address Fax Number:
304-344-2108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 LAIDLEY ST STE 307
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25301-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-208-1414
Provider Business Practice Location Address Fax Number:
304-344-2108
Provider Enumeration Date:
06/17/2006

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: 207RN0300X , with the licence number:  15775 , 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: 2496080 . This is a "OHIO JOB & FAMILY SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 614835100 . This is a "FEDERAL WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810000347 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197254861 . This is a "PEIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 271503047 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6608290 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1972548618 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10010042 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2496080 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271503047 . This is a "MSBCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com