NPIMap

Organization Active NPI

J Michael Petersen

  • Surgery Physician
  • Wheeling, WV
National Provider Identifier
1316461718
Registry record updated Aug 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
13832 Issued in WV
Legal business name
J MICHAEL PETERSEN
Practice address
2000 Eoff St
Wheeling, WV 26003-3823
Phone
(304) 233-2455
Fax
(304) 233-6073
NPI assigned
Jul 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2017

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

Authorized official

Name
Dr. J Michael Petersen, MD
Title
President
Phone
(304) 233-2455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X 13832 WV Primary

Addresses

Primary practice location

2000 Eoff St
Wheeling, WV 26003-3823

Mailing address

109 Mount Wood Rd
Wheeling, WV 26003-2632
Phone (304) 233-2455

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502236800000",
    "number": "1316461718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 MOUNT WOOD RD",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260032632",
            "telephone_number": "304-233-2455",
            "fax_number": "304-233-6073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 EOFF ST",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260033823",
            "telephone_number": "304-233-2455",
            "fax_number": "304-233-6073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J MICHAEL PETERSEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-28",
        "last_updated": "2017-08-09",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-233-2455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "WV",
            "license": "13832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheeling, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2017; 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.