NPIMap

Organization Active NPI

Kuruvilla John, MD, Inc.

  • Neurology Physician
  • South Charleston, WV
National Provider Identifier
1548314230
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
16097 Issued in WV
Legal business name
KURUVILLA JOHN, MD, INC.
Practice address
401 Division St
Suite 104
South Charleston, WV 25309-1455
Phone
(304) 767-7880
Fax
(304) 767-7885
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kuruvilla John, M.D.NPI 1295826493
Title
President
Phone
(304) 767-7880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X 16097 WV Primary

Addresses

Primary practice location

401 Division St
Suite 104
South Charleston, WV 25309-1455

Mailing address

401 Division St
Suite 104
South Charleston, WV 25309-1455
Phone (304) 767-7880

Other identifiers 1

IdentifierTypeStateIssuer
0089936000MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1548314230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 DIVISION ST",
            "address_2": "SUITE 104",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091455",
            "telephone_number": "304-767-7880",
            "fax_number": "304-767-7885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 DIVISION ST",
            "address_2": "SUITE 104",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091455",
            "telephone_number": "304-767-7880",
            "fax_number": "304-767-7885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KURUVILLA JOHN, MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHN",
        "authorized_official_first_name": "KURUVILLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-767-7880",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WV",
            "license": "16097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0089936000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.