Midtowne Family Practice PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1040 Issued in WV

Legal business name

MIDTOWNE FAMILY PRACTICE PLLC

Practice address

403 12TH Street Ext
Princeton, WV 24740-2300

Phone

(304) 431-9998

Fax

(304) 425-0782

NPI assigned

Aug 20, 2006

Organization subpart

No

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

Authorized official

Name

Pamela P. Faulkner, DO

Title

Physician/Owner

Phone

(304) 431-7100

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jamie Beth Carosi, PA

  • Medical Physician Assistant
  • Princeton, WV
  • NPI 1043477987
  Medicare reassignment
• Richard B Boone, DO

  • Family Medicine Physician
  • Vienna, WV
  • NPI 1023080215
  NPD (past)
• Michael O Crews, DO

  • Family Medicine Physician
  • Bland, VA
  • NPI 1215915137
  NPD (past)
• Manju Sheth, MD

  • Internal Medicine Physician
  • Danvers, MA
  • NPI 1790731487
  NPD (past)
• Ira G. Wong, M.D.

  • Ophthalmology Physician
  • San Francisco, CA
  • NPI 1194734715
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1154436004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1030",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247401030",
            "telephone_number": "304-431-7100",
            "fax_number": "304-431-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 12TH STREET EXT",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402300",
            "telephone_number": "304-431-9998",
            "fax_number": "304-425-0782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDTOWNE FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "304-431-7100",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "1040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0051816000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Merilic
• Don Merkle Jr.
• William A Merva, MD
• Sabrina Midkiff
• Samantha Midkiff
• Amanda Mika
• January Dawn Mikels
• Matthew Mikles
• Rhonda Milam
• Alexus Miller

• Family Medicine Physician in Princeton, WV
• Providers in Princeton, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.