1629241278 NPI number — HUGO J. ANDREINI JR.,M.D.,INC.

Table of content: (NPI 1629241278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629241278 NPI number — HUGO J. ANDREINI JR.,M.D.,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUGO J. ANDREINI JR.,M.D.,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:
1629241278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 MEDICAL PARK
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-6392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-242-0779
Provider Business Mailing Address Fax Number:
304-243-0653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 MEDICAL PARK
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-6392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-242-0779
Provider Business Practice Location Address Fax Number:
304-243-0653
Provider Enumeration Date:
04/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDREINI
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
304-277-1766

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  14036 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 35057824 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 25MAO4456100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD034699E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0707060 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0130000000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".