1104824382 NPI number — ROBERT POWELL CNP

Table of content: ROBERT POWELL CNP (NPI 1104824382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104824382 NPI number — ROBERT POWELL CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1104824382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
514 W ATLANTIC ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH HILL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23970-1906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-447-6969
Provider Business Mailing Address Fax Number:
434-447-2240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
514 W ATLANTIC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HILL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23970-1906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-447-6969
Provider Business Practice Location Address Fax Number:
434-447-2240
Provider Enumeration Date:
07/12/2005

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: 363LF0000X , with the licence number:  0024166051 , 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: 010125685 . This is a "VA PREMIER SOUTH HILL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 21524 . This is a "CARENET SH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010252393 . This is a "VA PREMIER KENB" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010252423 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21989 . This is a "CARENET KB" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 60109 . This is a "CARENET CC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00215680 . This is a "SH RR MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010125685 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010252393 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 224189800 . This is a "DOL" identifier . This identifiers is of the category "OTHER".




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