1932103579 NPI number — DR. FRANK A. MUTO M.D.

Table of content: KEAUNDRE LIKENS (NPI 1285345397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932103579 NPI number — DR. FRANK A. MUTO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUTO
Provider First Name:
FRANK
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1932103579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11137
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25339-1137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-344-3457
Provider Business Mailing Address Fax Number:
304-344-3480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1538 KANAWHA BLVD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25311-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-344-3457
Provider Business Practice Location Address Fax Number:
304-344-3480
Provider Enumeration Date:
06/10/2005

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: 2085R0202X , with the licence number:  21190 , 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: 14193 . This is a "CARELINK & CARELINK PEIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2402779 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64063985 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: H82260 . This is a "BRICKSTREET INSURANCE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0130753 . This is a "UMWA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 55-0516458 . This is a "GROUP FEIN #" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 550516458 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020011800 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001718808 . This is a "FREEDOM BLUE & MS BC BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 550516458 . This is a "ACORDIA NATIONAL PEIA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 151237200 . This is a "US DOL & US POSTAL COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3004087000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14175 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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