NPIMap

Organization Active NPI

Wvupc-Medicine & Specialty Office

Doing business as WVU Physicians of Charleston

  • Medical Specialty Clinic/Center
  • Charleston, WV
National Provider Identifier
1568769354
Registry record updated Feb 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
WVUPC-MEDICINE & SPECIALTY OFFICE
Doing business as
WVU Physicians of Charleston
Practice address
4522 Maccorkle Ave SE
Charleston, WV 25304-1840
Phone
(304) 347-1296
Fax
(304) 347-1394
NPI assigned
Feb 15, 2011
Last updated
Feb 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2011

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

Authorized official

Name
Terry D Miller
Title
Provider Relations Analyst
Phone
(304) 293-5033

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

4522 Maccorkle Ave SE
Charleston, WV 25304-1840

Mailing address

PO Box 7000
Morgantown, WV 26507-7000
Phone (304) 293-7401

Other identifiers 4

IdentifierTypeStateIssuer
00OtherWVWC FACILITY SUFFIX
4002106000MedicaidWV
51D0695014OtherWVCLIA FACILITY LAB NUMBER
121OtherWVWV BLUE SHIELD SUFFIX

Other names 1

  • WVU Physicians of Charleston Doing business as

National Provider Directory

National Provider Directory
Tax ID family
West Virginia University Physician of Charleston-Valley Center21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

4522 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 926-1001

NPI Registry JSON

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297728000000",
    "number": "1568769354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7000",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265077000",
            "telephone_number": "304-293-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4522 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041840",
            "telephone_number": "304-347-1296",
            "fax_number": "304-347-1394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WVUPC-MEDICINE & SPECIALTY OFFICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2011-02-15",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PROVIDER RELATIONS ANALYST",
        "authorized_official_telephone_number": "304-293-5033"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WC FACILITY SUFFIX",
            "identifier": "00",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4002106000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA FACILITY LAB NUMBER",
            "identifier": "51D0695014",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV BLUE SHIELD SUFFIX",
            "identifier": "121",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WVU Physicians of Charleston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; 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.