1093785115 NPI number — THOMAS E GRIFFITH

Table of content: THOMAS E GRIFFITH (NPI 1093785115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093785115 NPI number — THOMAS E GRIFFITH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFITH
Provider First Name:
THOMAS
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1093785115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ALBANS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25177-2821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-727-5237
Provider Business Mailing Address Fax Number:
304-727-4051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25177-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-727-5237
Provider Business Practice Location Address Fax Number:
304-727-4051
Provider Enumeration Date:
01/23/2006

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: 152W00000X , with the licence number:  608-OD , 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: 0150229000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com