1396941225 NPI number — GEORGE E. LOVEGROVE, M.D.

Table of content: (NPI 1396941225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396941225 NPI number — GEORGE E. LOVEGROVE, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE E. LOVEGROVE, M.D.
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:
1396941225
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:
4130 ROBERT C BYRD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BECKLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25801-2206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-252-3900
Provider Business Mailing Address Fax Number:
304-252-9311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4522 MACCORKLE AVE SE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25304-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-926-1001
Provider Business Practice Location Address Fax Number:
304-926-1003
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOVEGROVE
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-252-3900

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  11937 , 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: 3810002434 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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