1881850592 NPI number — DR. RONALD WAYNE BILLIPS MD

Table of content: DR. RONALD WAYNE BILLIPS MD (NPI 1881850592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881850592 NPI number — DR. RONALD WAYNE BILLIPS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BILLIPS
Provider First Name:
RONALD
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
DR.
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:
1881850592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3997 BECKLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24740-7660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-431-5499
Provider Business Mailing Address Fax Number:
304-431-3400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3016E CUMBERLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24701-4858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-431-5499
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2008

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: 207Q00000X , with the licence number:  23181 , 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: 1346266848 . This is a "GROUP NPI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1043387327 . This is a "PRUDICH MEDICAL NPI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1881850592 . This is a "MOUNTAIN STATE BC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0022360001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9232183 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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