1801050687 NPI number — ANGER FAMILY PRACTICE, PLLC

Table of content: (NPI 1801050687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801050687 NPI number — ANGER FAMILY PRACTICE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGER FAMILY PRACTICE, 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:
1801050687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29
Provider Second Line Business Mailing Address:
ANGER FAMILY PRACTICE, PLLC
Provider Business Mailing Address City Name:
ELKINS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26241-0029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-637-3439
Provider Business Mailing Address Fax Number:
304-637-3435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 BARNARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKINS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26241-3150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-636-0133
Provider Business Practice Location Address Fax Number:
304-637-2007
Provider Enumeration Date:
07/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ANGER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
304-636-0133

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20931 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 61887 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002051730 . This is a "MOUNTAIN STATE BCBS PAY TO #" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810012616 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: DO4248 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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