1881733616 NPI number — FMRS HEALTH SYSTEMS INC

Table of content: (NPI 1881733616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881733616 NPI number — FMRS HEALTH SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FMRS HEALTH SYSTEMS INC
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:
FMRS MENTAL HEALTH COUNCIL INC
Provider Other Organization Name Type Code:
4
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:
1881733616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 S EISENHOWER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BECKLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25801-4929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-256-7100
Provider Business Mailing Address Fax Number:
304-256-7160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S EISENHOWER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-4929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-256-7100
Provider Business Practice Location Address Fax Number:
304-256-7160
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REDMAN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
304-256-7100

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  8 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X , with the licence number: 8 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001709451 . This is a "BCBS PAY TO ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0005445002 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001709450 . This is a "BCBS PAY TO ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0005445001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005445000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001802529 . This is a "BCBS PAY TO ID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0134961 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810003487 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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