NPIMap

Organization Active NPI

Medabolix, Inc.

  • Registered Dietitian
  • Charleston, WV
National Provider Identifier
1780898072
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
MEDABOLIX, INC.
Practice address
600 Tracy Way
Suite 200
Charleston, WV 25311-1262
Phone
(304) 347-4313
Fax
(304) 347-4316
NPI assigned
May 9, 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
Daniel Stickler II, M.D.
Title
President Ceo
Phone
(304) 347-4313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

600 Tracy Way
Suite 200
Charleston, WV 25311-1262

Mailing address

600 Tracy Way
Suite 200
Charleston, WV 25311-1262
Phone (304) 347-4313

National Provider Directory

National Provider Directory

Locations

600 Tracy Way
#200
Charleston, WV 25311
Phone (304) 347-4313

Practitioners & affiliated clinicians

Practitioners 1

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": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780898072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 TRACY WAY",
            "address_2": "SUITE 200",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111262",
            "telephone_number": "304-347-4313",
            "fax_number": "304-347-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 TRACY WAY",
            "address_2": "SUITE 200",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111262",
            "telephone_number": "304-347-4313",
            "fax_number": "304-347-4316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDABOLIX, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STICKLER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "304-347-4313",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 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.