Provider Demographics
NPI:1497839021
Name:RICHEY FAS LLC
Entity Type:Organization
Organization Name:RICHEY FAS LLC
Other - Org Name:RICHEY AND COMPANY SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-975-5434
Mailing Address - Street 1:1411 SACHEM PL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2556
Mailing Address - Country:US
Mailing Address - Phone:434-975-5434
Mailing Address - Fax:434-975-0081
Practice Address - Street 1:443 DANIELS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1359
Practice Address - Country:US
Practice Address - Phone:919-833-4484
Practice Address - Fax:919-833-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703854Medicaid
1239660005Medicare NSC
NC1239660005Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER