1316053705 NPI number — JAMES EDWARD CAPAGE PH.D.

Table of content: DR. NATHAN MILLER M.D. (NPI 1477995660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316053705 NPI number — JAMES EDWARD CAPAGE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAPAGE
Provider First Name:
JAMES
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.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:
1316053705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4498
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26504-4498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-599-5073
Provider Business Mailing Address Fax Number:
304-599-1955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 VISTA PLACES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-2363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-599-5073
Provider Business Practice Location Address Fax Number:
304-599-1955
Provider Enumeration Date:
08/21/2006

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: 103T00000X , with the licence number:  112 , 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: 125310 . This is a "COMP PSYCH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4293759 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: Y319197 . This is a "THP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 252787 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 252787 . This is a "MAMSI- OPTIMUM CHOICE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 5506874997211 . This is a "COMMUNITY INS. COMPANY" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810009613 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125310 . This is a "MAGELLAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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