1164516803 NPI number — JONATHAN B MURPHY MD INC

Table of content: (NPI 1164516803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164516803 NPI number — JONATHAN B MURPHY MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONATHAN B MURPHY 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:
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:
1164516803
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:
PO BOX 1518
Provider Second Line Business Mailing Address:
SIXTH AVE AND SECOND STREET
Provider Business Mailing Address City Name:
SAINT ALBANS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25177-6011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-201-3600
Provider Business Mailing Address Fax Number:
304-201-2368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MAIN ST # 1518
Provider Second Line Business Practice Location Address:
SIXTH AVE AND SECOND STREET
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25177-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-201-3600
Provider Business Practice Location Address Fax Number:
304-201-2368
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-201-3600

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1479 , 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: 1479 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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