1174584353 NPI number — RUSSELL BIUNDO MD INC

Table of content: (NPI 1174584353)

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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