Carlos C. Jimenez MD Professional Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

10223 Issued in WV

Legal business name

CARLOS C. JIMENEZ MD PROFESSIONAL CORPORATION

Practice address

1000 Wheeling Ave
Glen Dale, WV 26038-1750

Phone

(304) 845-1331

Fax

(304) 845-9152

NPI assigned

Oct 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carlos C Jimenez, MD

Title

Owner

Phone

(304) 845-1331

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1124216742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 WHEELING AVE",
            "city": "GLEN DALE",
            "state": "WV",
            "postal_code": "260381750",
            "telephone_number": "304-845-1331",
            "fax_number": "304-845-9152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WHEELING AVE",
            "city": "GLEN DALE",
            "state": "WV",
            "postal_code": "260381750",
            "telephone_number": "304-845-1331",
            "fax_number": "304-845-9152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLOS C. JIMENEZ MD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-845-1331",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "10223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0076414000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Bonar, FNP-BC
• Dakota Benjamin Brooker, PA-C
• Yekaterina O Brown, DO
• Michael Warren Burkhart, M.D.
• Alexa Bushovisky
• Michael Carney, DO
• Charles L. Wylie DDS Group
• Angela Cisar
• Bradlee Christopher Clark
• Braylynn Diane Clark, APRN

• Internal Medicine Physician in Glen Dale, WV
• Providers in Glen Dale, WV by specialty
• Internal Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.