NPIMap

Organization Active NPI

Fairmont General Mdgrp

  • Specialist
  • Fairmont, WV
National Provider Identifier
1215117262
Registry record updated Nov 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
9 Issued in WV
Legal business name
FAIRMONT GENERAL MDGRP
Practice address
1325 Locust Ave
Fairmont, WV 26554-1435
Phone
(304) 367-7100
Fax
(304) 333-2617
NPI assigned
Nov 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2007

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

Authorized official

Name
Michael J Sengewalt
Title
Senior VP and Cfo
Phone
(304) 367-7152

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 9 WV Primary

Addresses

Primary practice location

1325 Locust Ave
Fairmont, WV 26554-1435

Mailing address

1325 Locust Ave
Fairmont, WV 26554-1435
Phone (304) 367-7100

Other identifiers 1

IdentifierTypeStateIssuer
0001118003MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Fairmont General Hospital2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1215117262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 LOCUST AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541435",
            "telephone_number": "304-367-7100",
            "fax_number": "304-333-2617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 LOCUST AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541435",
            "telephone_number": "304-367-7100",
            "fax_number": "304-333-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRMONT GENERAL MDGRP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "SENGEWALT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SENIOR VP AND CFO",
        "authorized_official_telephone_number": "304-367-7152"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WV",
            "license": "9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001118003",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairmont, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.

Verify at the official NPI Registry.