1275558017 NPI number — CENTRAL WV MEDCORP, INC.

Table of content: (NPI 1275558017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275558017 NPI number — CENTRAL WV MEDCORP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL WV MEDCORP, 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:
1275558017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2630
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26241-2630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-637-3736
Provider Business Mailing Address Fax Number:
304-637-3369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 N LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-472-1600
Provider Business Practice Location Address Fax Number:
304-472-6382
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMER
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
304-637-3156

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Y00000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3810010990 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000897320 . This is a "MT ST BCBS GROUP NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 151585801 . This is a "DOL FEDERAL BLACK LUNG PR" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001710531 . This is a "MT ST BCBS PAC PAY TO #" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 020935300 . This is a "DOL FEDERAL BLACK LUNG PR" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0009078000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020935302 . This is a "DOL FEDERAL BLACK LUNG PR" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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