1669511135 NPI number — HENRY P. GOSIENE,M.D.,P.C.

Table of content: (NPI 1669511135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669511135 NPI number — HENRY P. GOSIENE,M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY P. GOSIENE,M.D.,P.C.
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:
1669511135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 MALLARD CT
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:
25801-3615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-252-4216
Provider Business Mailing Address Fax Number:
304-253-6809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 MALLARD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-252-4216
Provider Business Practice Location Address Fax Number:
304-253-6809
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOSIENE
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-252-4216

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  00603 , 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: 1043213762 . This is a "NPI HENRY P GOSIENE M.D." identifier . This identifiers is of the category "OTHER".
  • Identifier: 9188541 . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1437241346 . This is a "TAOUFIK SADAT M.D. , NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: CJ9809 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0095654001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0240042000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0425002 . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".




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