NPI |
1205595840 |
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 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
SENTARA THERAPY SOLUTIONS, LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
95 DUNN DR STE 123 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
STAFFORD |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
VA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
225561503 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
5402424489 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
7574257180 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
12/10/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
12/10/2021 |
The code designating the provider’s gender if the provider is a person. |
Authorized Official Last Name |
PRINCE |
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 |
DORIS |
The first name of the authorized official. |
Authorized Official Title or Position |
DIRECTOR |
The title or position of the authorized official. |
Authorized Official Telephone Number |
5798354757 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
111N00000X |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
225100000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Healthcare Provider Taxonomy Code 3 |
225700000X |
|
Healthcare Provider Primary Taxonomy Switch 3 |
N |
|
Healthcare Provider Taxonomy Code 4 |
225X00000X |
|
Healthcare Provider Primary Taxonomy Switch 4 |
N |
|
Healthcare Provider Taxonomy Code 5 |
235Z00000X |
|
Healthcare Provider Primary Taxonomy Switch 5 |
N |
|
Is Organization Subpart |
N |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 2 |
193200000X MULTI-SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 3 |
193200000X MULTI-SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 4 |
193200000X MULTI-SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 5 |
193200000X MULTI-SPECIALTY GROUP |
|
NPI Certification Date |
12/10/2021 |
|