Braddock Medical Group P.a., NPI 1104962729
Adult Medicine Physician in Fort Ashby, WV, US
NPI number: what is it?
The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...
| NPI | 1104962729 |
| NPI Entity Type | Organization |
| Provider Name |
Braddock Medical Group P.a.
Other Name |
| Subpart of Organization | Braddock Medical Group Pa |
| Enumeration Date | September 30, 2009 |
| Last Update Date | September 30, 2009 |
| Provider Location Address | 70 Presidents Street, Unit 1150, Fort Ashby, WV, US |
| Provider Mailing Address | 70 Presidents Street, Fort Ashby, WV, US, 267191150 |
| Is Sole Proprietor? | No |
Organization Official
| Official Name | DR. MD Paul Taylor Livengood |
| Official Position | OWNER |
| Phone | 304-298-3605 |
Group Taxonomy
| Taxonomy Code | 193400000X |
| Taxonomy Name | 193400000X SINGLE SPECIALTY GROUP |
| Definition | A business group of one or more individual practitioners, all of who practice with the same area of specialization. |
Primary Taxonomy
| Taxonomy Code | |
| Taxonomy Name | Adult Medicine Physician |
| Classification | |
| Group | |
| License No. | 11172 |
| License State | WV |
| Description | Definition to come. |
Other Identifiers
| Identifier | Identifier State | Identifier Issuer | Type/Code |
|---|---|---|---|
| 850-290 | MAMSI MDIPA OPTIMUM | 01 | |
| H529BR | MD | BCBS GROUP # | 01 |
| W399 | BCBS FEDERAL PROVIDER # | 01 | |
| 00716943 | WV | BCBS PROVIDER # | 01 |
| 41707101 | MD | BCBS PROVIDER # | 01 |
| 3810000010 | WV | MEDICAID | 05 |
| 0003 | BCBS FEDERAL GROUP # | 01 | |
| 0056043000 | WV | MEDICAID | 05 |
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