1124297346 NPI number — CENTRAL WV MEDCORP, INC

Table of content: (NPI 1124297346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124297346 NPI number — CENTRAL WV MEDCORP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL WV MEDCORP, 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:
CENTRAL WVMEDCORP LOC LAB
Provider Other Organization Name Type Code:
3
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:
1124297346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2630
Provider Second Line Business Mailing Address:
CENTRAL WV MEDCORP, INC.
Provider Business Mailing Address City Name:
ELKINS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26241-2630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-637-3799
Provider Business Mailing Address Fax Number:
304-637-3369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 N LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-4968
Provider Business Practice Location Address Fax Number:
304-472-6382
Provider Enumeration Date:
02/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PICCIRILLO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-636-7451

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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: 51D1061952 . This is a "CLIA NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0009078001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51D0915651 . This is a "CLIA NUMBERS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 51D1070912 . This is a "CLIA NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 51D1062732 . This is a "CLIA NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 51D1082791 . This is a "CLIA NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 51D1017352 . This is a "CLIA NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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