1386608040 NPI number — CHRISTOPHER L DEWESE MD

Table of content: CHRISTOPHER L DEWESE MD (NPI 1386608040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386608040 NPI number — CHRISTOPHER L DEWESE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEWESE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386608040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-3656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-691-8870
Provider Business Mailing Address Fax Number:
304-757-0042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 STATION PLACE WAY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HURRICANE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25526-8747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-691-8870
Provider Business Practice Location Address Fax Number:
304-757-0042
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  20192 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1801215000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2205689 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64025638 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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