1992758411 NPI number — JAMES ROBERT TOOTHMAN D.O.

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 1992758411 NPI number — JAMES ROBERT TOOTHMAN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOOTHMAN
Provider First Name:
JAMES
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1992758411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/12/2024
NPI Reactivation Date:
01/25/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 EDGEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURRICANE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25526-9218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-539-5557
Provider Business Mailing Address Fax Number:
304-757-5557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 EDGEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURRICANE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25526-9218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-539-5557
Provider Business Practice Location Address Fax Number:
304-757-5557
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  1441 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 146D00000X , with the licence number: 1441 , 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: 110135471 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2047636 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000712231 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0045606000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023206600 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 550737998 . This is a "WV WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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