Provider Demographics
NPI:1043344682
Name:COAL VALLEY PHYSICIANS INC
Entity Type:Organization
Organization Name:COAL VALLEY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:AKERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-442-9582
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-0330
Mailing Address - Country:US
Mailing Address - Phone:304-233-9314
Mailing Address - Fax:304-233-0265
Practice Address - Street 1:401 6TH AVE
Practice Address - Street 2:D303
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2116
Practice Address - Country:US
Practice Address - Phone:304-442-9582
Practice Address - Fax:304-442-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0050281000Medicaid
WV0531364Medicare PIN