1972797256 NPI number — COLONIAL HEIGHTS PEDIATRICS LTD.

Table of content: (NPI 1972797256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972797256 NPI number — COLONIAL HEIGHTS PEDIATRICS LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLONIAL HEIGHTS PEDIATRICS LTD.
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:
1972797256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16011 KAIROS RD
Provider Second Line Business Mailing Address:
SUITE 'A'
Provider Business Mailing Address City Name:
COLONIAL HEIGHTS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23834-5205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-520-2600
Provider Business Mailing Address Fax Number:
604-520-5853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16011 KAIROS RD
Provider Second Line Business Practice Location Address:
SUITE 'A'
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834-5205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-520-2600
Provider Business Practice Location Address Fax Number:
604-520-5853
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IQBAL
Authorized Official First Name:
JAWED
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
804-520-2600

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , 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: G62833 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G61226 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com