1376577494 NPI number — SCOTT G HUNTER PAC

Table of content: SCOTT G HUNTER PAC (NPI 1376577494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376577494 NPI number — SCOTT G HUNTER PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNTER
Provider First Name:
SCOTT
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
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:
1376577494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16000 JOHNSTON MEMORIAL DR
Provider Second Line Business Mailing Address:
FOURTH FLOOR
Provider Business Mailing Address City Name:
ABINGDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24211-7664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-258-4050
Provider Business Mailing Address Fax Number:
276-258-4056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16000 JOHNSTON MEMORIAL DR
Provider Second Line Business Practice Location Address:
FOURTH FLOOR
Provider Business Practice Location Address City Name:
ABINGDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24211-7664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-258-4050
Provider Business Practice Location Address Fax Number:
276-258-4056
Provider Enumeration Date:
07/11/2006

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: 363A00000X , with the licence number:  0110001355 , 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: 9000189 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q006222 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1376577494 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00672322 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com