Braddock Medical Group P.A. in Fort Ashby - Adult Medicine
Braddock Medical Group P.A. - NPI 1104962729
Braddock Medical Group P.A. is a Adult Medicine in Fort Ashby, . Braddock Medical Group P.A. practices all healthcare services and medical treatments related to Adult Medicine. The NPI Number for Braddock Medical Group P.A. is 1104962729. The last update date is 2016-11-01.
Braddock Medical Group P.A.'s current location address is 70 Presidents Street, Fort Ashby, . You can contact this provider via phone number 3042983605 and fax number 3042983578. The mailing address for Braddock Medical Group P.A. is 70 Presidents Street, Fort Ashby, . To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Braddock Medical Group P.A. |
|---|---|
| Address | 70 Presidents Street, Fort Ashby, |
| Phone Number | 3042983605 |
| Fax Number | 3042983578 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | OWNER |
|---|---|
| Authorized Official Name | Livengood Taylor Paul |
| Credentials | MD |
| Telephone Number | 3042983605 |
NPI Number Detail
| NPI Number | 1104962729 |
|---|---|
| Provider Enumeration Date | 2007-01-30 |
| Last Updated Date | 2016-11-01 |
Provider Mailing Address Detail
| Address | 70 Presidents Street |
|---|---|
| City | Fort Ashby |
| State | (WV) |
| Post Code | 267191150 |
| Phone Number | 3042983605 |
| Fax Number | 3042983578 |
Provider's Primary Taxonomy Detail
| Speciality | Adult Medicine |
|---|---|
| Taxonomy | 207Qa0505X |
| Licence No | 11172 |
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Definition: The NUCC recommends this code not be used. Choose a more appropriate code. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 850-290 | MAMSI MDIPA OPTIMUM | ||
| H529BR | MD | BCBS GROUP # | |
| W399 | BCBS FEDERAL PROVIDER # | ||
| 716943 | WV | BCBS PROVIDER # | |
| 41707101 | MD | BCBS PROVIDER # | |
| 3810000010 | WV | -- | |
| 3 | BCBS FEDERAL GROUP # | ||
| 56043000 | WV | -- |
Post Comment/ Review Below
What is the unique 10-digit identifier code assigned to Braddock Medical Group P.A. by the Centers for Medicare & Medicaid Services?
The Braddock Medical Group P.A. has been issued the NPI (National Provider Identifier) 1104962729 by the CMS (Centers for Medicare & Medicaid Services), which serves as a unique identification number for healthcare providers.
Could you kindly provide the complete physical address where Braddock Medical Group P.A.'s facilities are geographically located?
The facilities of Braddock Medical Group P.A. are physically situated at the following location: 70 Presidents Street, Fort Ashby, WV, 267191150.
What is Braddock Medical Group P.A.'s specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Braddock Medical Group P.A.'s specialized field of practice is Adult Medicine, and the corresponding taxonomy code that categorizes this area of specialization is 207Qa0505X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1104962729 to Braddock Medical Group P.A.?
The Centers for Medicare & Medicaid Services originally issued the 1104962729 to Braddock Medical Group P.A. on 2007-01-30.
When was the information regarding Braddock Medical Group P.A. most recently updated?
The details pertaining to the Braddock Medical Group P.A., including its address, specialty, and other relevant information, were last refreshed on 2016-11-01.