1477733467 NPI number — VICTORINO D CHIN MD (DBA HOLY FAMILY HEALTH CLINIC)

Table of content: (NPI 1477733467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477733467 NPI number — VICTORINO D CHIN MD (DBA HOLY FAMILY HEALTH CLINIC)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORINO D CHIN MD (DBA HOLY FAMILY HEALTH CLINIC)
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:
1477733467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNDSVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26041-0964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-845-1460
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNDSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26041-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-845-1460
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHIN
Authorized Official First Name:
VICTORINO
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
304-845-1460

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35035509C , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 10205 , 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: 0169884 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007241000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021029481 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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