1578675492 NPI number — SAMUEL A MUSCARI SR. DO

Table of content: SAMUEL A MUSCARI SR. DO (NPI 1578675492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578675492 NPI number — SAMUEL A MUSCARI SR. DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUSCARI
Provider First Name:
SAMUEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
SR.
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1578675492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1650
Provider Second Line Business Mailing Address:
MAIN STREET FAMILY HEALTH CARE ASSOCIATES INC
Provider Business Mailing Address City Name:
PINEVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24874-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-732-6735
Provider Business Mailing Address Fax Number:
304-732-9218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 HOWARD AVENUE
Provider Second Line Business Practice Location Address:
FAMILY HEALTHCARE ASSOC INC
Provider Business Practice Location Address City Name:
MULLENS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-294-4880
Provider Business Practice Location Address Fax Number:
304-294-6480
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  466 , 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: 0049249-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0894794 . This is a "MAN" identifier . This identifiers is of the category "OTHER".




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