1174584353 NPI number — RUSSELL BIUNDO MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174584353 NPI number — RUSSELL BIUNDO MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSSELL BIUNDO MD 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:
1174584353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1160 VAN VOORHIS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26505-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-598-1122
Provider Business Mailing Address Fax Number:
304-598-1124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 VAN VOORHIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-598-1122
Provider Business Practice Location Address Fax Number:
304-598-1124
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIUNDO
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-598-1122

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , 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: 784081100 . This is a "MARYLAND MEDICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0016737660001 . This is a "PENNSYLVANIA MEDICAID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1424801 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 198177 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001707270 . This is a "MT STATE BLUE CROSS BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CG6938 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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