1467542183 NPI number — ALWAHIDO MEDICAL CORPORATION M C

Table of content: DR. MATTHEW JON DAVIS D.C. (NPI 1811924921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467542183 NPI number — ALWAHIDO MEDICAL CORPORATION M C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALWAHIDO MEDICAL CORPORATION M C
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:
1467542183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 299
Provider Second Line Business Mailing Address:
STANAFORD MEDICAL CLINIC
Provider Business Mailing Address City Name:
STANAFORD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25927-0299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-256-8227
Provider Business Mailing Address Fax Number:
304-256-8214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 STANAFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-256-8227
Provider Business Practice Location Address Fax Number:
304-256-8214
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAFARY
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR OFFICE MANAGER
Authorized Official Telephone Number:
304-256-8227

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810002364 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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