1013113083 NPI number — ROBERT C. PENNINGTON, MD, PC

Table of content: (NPI 1013113083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013113083 NPI number — ROBERT C. PENNINGTON, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT C. PENNINGTON, MD, PC
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:
1013113083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 COURTHOUSE ROAD
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:
24740-2421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-487-2297
Provider Business Mailing Address Fax Number:
304-487-4802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 COURTHOUSE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-487-2297
Provider Business Practice Location Address Fax Number:
304-487-4802
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PENNINGTON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-425-2297

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  25068 , 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: 562129755 . This is a "TAX IDENTIFIER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 86314 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810024625 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89-1070V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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