1437254927 NPI number — WHEELERSBURG INTERNAL MEDICINE GROUP INC

Table of content: (NPI 1437254927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437254927 NPI number — WHEELERSBURG INTERNAL MEDICINE GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHEELERSBURG INTERNAL MEDICINE GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1437254927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 628
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELERSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45694-0628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-574-1500
Provider Business Mailing Address Fax Number:
740-574-9575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8048 OHIO RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEELERSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45694-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-574-1500
Provider Business Practice Location Address Fax Number:
740-574-9575
Provider Enumeration Date:
09/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KALO
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
MOUHIB
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
740-574-1500

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35077644 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2879489 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD5294 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".