Provider Demographics
NPI:1114342243
Name:ANCHOR MEDICAL LLC
Entity Type:Organization
Organization Name:ANCHOR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC
Authorized Official - Phone:304-253-5155
Mailing Address - Street 1:106 LOCKHEED DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-8962
Mailing Address - Country:US
Mailing Address - Phone:304-253-5155
Mailing Address - Fax:
Practice Address - Street 1:106 LOCKHEED DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-8962
Practice Address - Country:US
Practice Address - Phone:304-253-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV51350363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVD511Medicare PIN