1578528147 NPI number — GRETCHEN E OLEY MD

Table of content: GRETCHEN E OLEY MD (NPI 1578528147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578528147 NPI number — GRETCHEN E OLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLEY
Provider First Name:
GRETCHEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1578528147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2012
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:
SUITE G500
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:
304-691-1000
Provider Business Mailing Address Fax Number:
304-691-1693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE G500
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-3656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-691-1000
Provider Business Practice Location Address Fax Number:
304-691-1693
Provider Enumeration Date:
04/18/2006

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: 207R00000X , with the licence number:  13570 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , with the licence number: 13570 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: 13570 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0084682000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0606277 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64696008 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".