NPIMap

Organization Active NPI

West Virginia University Medical Corporation

Doing business as WVU Obstetrics & Gynecology-Bridgeport

  • Clinical Medical Laboratory
  • Bridgeport, WV
National Provider Identifier
1457605404
Registry record updated Oct 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
51D2012387 Issued in WV
Legal business name
WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION
Doing business as
WVU Obstetrics & Gynecology-Bridgeport
Practice address
527 Medical Park Dr
Suite 108
Bridgeport, WV 26330-9008
Phone
(304) 848-2152
NPI assigned
Oct 30, 2012
Last updated
Oct 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2012

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

Authorized official

Name
Terry D Miller
Title
Provider Enrollment Specialist
Phone
(304) 285-7101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 51D2012387 WV Primary

Addresses

Primary practice location

527 Medical Park Dr
Suite 108
Bridgeport, WV 26330-9008

Mailing address

P O Box 780
Morgantown, WV 26507-0780
Phone (304) 285-7101

Other identifiers 1

IdentifierTypeStateIssuer
0011526000MedicaidWV

Other names 1

  • WVU Obstetrics & Gynecology-Bridgeport Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000207 WV Part B Supplier - Clinic/Group Practice 1052224565 Receives reassigned benefits from 2,746 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Uha Camc Memorial Hospi204 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2601 Cranberry Sq
Morgantown, WV 26508
Phone (304) 285-1702

3803 Emerson Ave
Parkersburg, WV 26104
Phone (304) 485-5041

Practitioners & affiliated clinicians

Practitioners 99

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 99

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1457605404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 780",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265070780",
            "telephone_number": "304-285-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 MEDICAL PARK DR",
            "address_2": "SUITE 108",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309008",
            "telephone_number": "304-848-2152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "304-285-7101"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": "51D2012387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011526000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WVU Obstetrics & Gynecology-Bridgeport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; 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.