Provider Demographics
NPI:1033516646
Name:MICHAEL L FERREBEE, M.D., PLLC
Entity Type:Organization
Organization Name:MICHAEL L FERREBEE, M.D., PLLC
Other - Org Name:BLACK DIAMOND HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERREBEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-319-0841
Mailing Address - Street 1:PO BOX 4360
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26504-4360
Mailing Address - Country:US
Mailing Address - Phone:304-319-0841
Mailing Address - Fax:304-599-2448
Practice Address - Street 1:1325 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1435
Practice Address - Country:US
Practice Address - Phone:304-367-7510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18262207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty