1497135719 NPI number — HEALING WAYS HEALTHCARE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497135719 NPI number — HEALING WAYS HEALTHCARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING WAYS HEALTHCARE, PLLC
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:
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:
1497135719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1683
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHEPHERDSTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25443-1683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-261-0313
Provider Business Mailing Address Fax Number:
304-876-2001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 S PRINCESS STREET SUITE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEPHERDSTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25443-1683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-261-0313
Provider Business Practice Location Address Fax Number:
304-876-2001
Provider Enumeration Date:
06/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MACIUNAS
Authorized Official First Name:
KRISTINA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR PHYSICIAN
Authorized Official Telephone Number:
304-261-0313

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  17514 , 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: 0045551000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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