=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629248521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TELAMON CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2008
-----------------------------------------------------
Last Update Date | 03/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 W SIOUX LN
-----------------------------------------------------
City | ROMNEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26757-1431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-822-4514
-----------------------------------------------------
Fax | 304-822-4515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3937 WESTERN BLVD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27606-1936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-239-8115
-----------------------------------------------------
Fax | 919-851-1139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF FINANCE
-----------------------------------------------------
Name | MR. DAVID A CROOKE
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 919-239-8115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------