Provider Demographics
NPI:1083717375
Name:ALLEGHANY MEDICAL SERVICES, PC
Entity Type:Organization
Organization Name:ALLEGHANY MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:GORDINHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-254-9022
Mailing Address - Street 1:310 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2653
Mailing Address - Country:US
Mailing Address - Phone:304-254-9022
Mailing Address - Fax:304-254-9024
Practice Address - Street 1:1 ARH LANE, SUITE 100
Practice Address - Street 2:
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-862-6520
Practice Address - Fax:540-862-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCK7027OtherRAILROAD MEDICARE
WVCE9629OtherRAILROAD MEDICARE
WVP00106734OtherRAILROAD MEDICARE
VA005806437Medicaid
WV110157801OtherRAILROAD MEDICARE
WV0070431000Medicaid
P00177367OtherRAILROAD MEDICARE
WV3810006041Medicaid
WV0072202000Medicaid
P00177367OtherRAILROAD MEDICARE
WVCE9629OtherRAILROAD MEDICARE
WV3810006041Medicaid