Provider Demographics
NPI:1134142144
Name:CHARLESTON PSYCHIATRIC GROUP, INC.
Entity Type:Organization
Organization Name:CHARLESTON PSYCHIATRIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:SILAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-344-0349
Mailing Address - Street 1:1215 QUARRIER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1809
Mailing Address - Country:US
Mailing Address - Phone:304-344-0349
Mailing Address - Fax:304-344-0384
Practice Address - Street 1:1215 QUARRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1809
Practice Address - Country:US
Practice Address - Phone:304-344-0349
Practice Address - Fax:304-344-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0011908000Medicaid
WVCH9216172Medicare ID - Type Unspecified