1003053158 NPI number — RICHMOND COUNTY BOARD OF SUPERVISORS

Table of content: (NPI 1003053158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003053158 NPI number — RICHMOND COUNTY BOARD OF SUPERVISORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHMOND COUNTY BOARD OF SUPERVISORS
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:
1003053158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636635
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-424-3701
Provider Business Mailing Address Fax Number:
937-291-2971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 COURT CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-333-5089
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DUNCANSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
COUNTY ADMINISTRATOR
Authorized Official Telephone Number:
804-333-3415

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1284 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 1284 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1003053158 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00707651 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003053158 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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