Provider Demographics
NPI:1225378292
Name:ANDY L. EAGLE, JR.
Entity Type:Organization
Organization Name:ANDY L. EAGLE, JR.
Other - Org Name:EAGLE ELECTRIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EAGLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:434-736-8887
Mailing Address - Street 1:15153 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:KEYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23947-4402
Mailing Address - Country:US
Mailing Address - Phone:434-736-8887
Mailing Address - Fax:
Practice Address - Street 1:15153 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23947-4402
Practice Address - Country:US
Practice Address - Phone:434-736-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705037850171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2705037850OtherBUSINESS CONTRACTOR'S LICENSE NUMBER