Provider Demographics
NPI:1174681761
Name:CVMS SPECIALIST LLC
Entity Type:Organization
Organization Name:CVMS SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYAPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-282-8746
Mailing Address - Street 1:1 ROSS PARK BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2681
Mailing Address - Country:US
Mailing Address - Phone:740-282-8746
Mailing Address - Fax:740-282-2800
Practice Address - Street 1:1 ROSS PARK BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2681
Practice Address - Country:US
Practice Address - Phone:740-282-8746
Practice Address - Fax:740-282-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2142578Medicaid
WV3810010266Medicaid
WV9348002Medicare PIN
OH9348001Medicare PIN