Institute of Disability Medicine Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

9751 Issued in WV

Legal business name

INSTITUTE OF DISABILITY MEDICINE INC.

Practice address

40 Medical Park
Suite 304
Wheeling, WV 26003-6392

Phone

(304) 242-2503

Fax

(304) 242-2682

NPI assigned

Apr 24, 2007

Organization subpart

No

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

Authorized official

Name

Srini Govindan, M.D.

Title

President

Phone

(304) 242-2503

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201132800000",
    "number": "1306064118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 MEDICAL PARK",
            "address_2": "SUITE 304",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036392",
            "telephone_number": "304-242-2503",
            "fax_number": "304-242-2682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 MEDICAL PARK",
            "address_2": "SUITE 304",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036392",
            "telephone_number": "304-242-2503",
            "fax_number": "304-242-2682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE OF DISABILITY MEDICINE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2008-01-24",
        "status": "A",
        "authorized_official_last_name": "GOVINDAN",
        "authorized_official_first_name": "SRINI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-242-2503",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WV",
            "license": "9751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0090961000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "9751",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Wheeling, WV
• Providers in Wheeling, WV by specialty
• Specialist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; 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.