1376593434 NPI number — UNIVERSITY PHYSICIANS & SURGEONS, INC

Table of content: PEYTON CHARIS MOHR AUD (NPI 1205511805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376593434 NPI number — UNIVERSITY PHYSICIANS & SURGEONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PHYSICIANS & SURGEONS, 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:
6
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:
1376593434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
SUITE 2500
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-3656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-691-1200
Provider Business Mailing Address Fax Number:
304-691-1287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 20TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25703-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-523-6421
Provider Business Practice Location Address Fax Number:
304-523-8506
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOVINS
Authorized Official First Name:
PAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
304-691-1640

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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