1073538039 NPI number — THE HEALTH CENTER PLLC

Table of content: (NPI 1073538039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073538039 NPI number — THE HEALTH CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEALTH CENTER PLLC
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:
1073538039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2367
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
WEIRTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26062-1567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-723-6040
Provider Business Mailing Address Fax Number:
304-723-6039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2423 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WEIRTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26062-3632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-723-5340
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACPHERSON
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-723-5340

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  302 , 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: 3810008065 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com