NPI |
1790056372 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The middle name of the authorized official. |
Employer Identification Number EIN |
|
The title or position of the authorized official. |
Provider Organization Name Legal Business Name |
U. S. NAVY |
The 10-position telephone number of the authorized official. |
Provider First Line Business Practice Location Address |
3423 GUADALCANAL RD |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Second Line Business Practice Location Address |
BLDG 401 2ND DECK |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Business Practice Location Address City Name |
SAN DIEGO |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider Business Practice Location Address State Name |
CA |
|
Provider Business Practice Location Address Postal Code |
921555000 |
|
Provider Business Practice Location Address Country Code If outside U S |
US |
|
Provider Business Practice Location Address Telephone Number |
6195371304 |
|
Provider Enumeration Date |
1/13/2012 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
1/13/2012 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
ACHEAMPONG |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
NICHOLAS |
The first name of the authorized official. |
Authorized Official Middle Name |
SARKODIE |
The middle name of the authorized official. |
Authorized Official Title or Position |
INDEPENDENT DUTY CORPSMAN |
The title or position of the authorized official. |
Authorized Official Telephone Number |
6195371335 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
286500000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Credential Text |
IDC |
|