Active NPI
Lisa Ann Waugh, LMT
- Sports Medicine (Neuromusculoskeletal Medicine) Physician
- S Charleston, WV
National Provider Identifier
1053517011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Neuromusculoskeletal Medicine) Physician
- License
- 0388
- Practice address
- 1109 Jefferson Rd
S Charleston, WV 25309-9780 - Phone
- (304) 610-7888
- NPI assigned
- Jun 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Neuromusculoskeletal Medicine) Physician | 204C00000X | 0388 | WV | Primary |
Addresses
Primary practice location
1109 Jefferson Rd
S Charleston, WV 25309-9780
Mailing address
2939 Shadyside Rd
St Albans, WV 25177
Phone (304) 610-7888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0388 | Other | WV | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0388 | WV | MD | Sports Medicine (Neuromusculoskeletal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053517011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2939 SHADYSIDE RD",
"city": "ST ALBANS",
"state": "WV",
"postal_code": "25177",
"telephone_number": "304-610-7888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1109 JEFFERSON RD",
"city": "S CHARLESTON",
"state": "WV",
"postal_code": "253099780",
"telephone_number": "304-610-7888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAUGH",
"first_name": "LISA",
"middle_name": "ANN",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "204C00000X",
"taxonomy_group": "",
"desc": "Neuromusculoskeletal Medicine, Sports Medicine",
"state": "WV",
"license": "0388",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "0388",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in S Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.