Provider Demographics
NPI:1205008711
Name:MELISSA A. CHAPMAN, D.O.
Entity Type:Organization
Organization Name:MELISSA A. CHAPMAN, D.O.
Other - Org Name:MIDDLE CROSS FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-929-7677
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-0972
Mailing Address - Country:US
Mailing Address - Phone:304-929-7677
Mailing Address - Fax:304-929-6067
Practice Address - Street 1:102 RESERVATION AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2820
Practice Address - Country:US
Practice Address - Phone:304-929-7677
Practice Address - Fax:304-929-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1811261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMESP05281OtherMEDICARE SOLE PROP. PIN
WV1809819-000Medicaid
WVMESP05281OtherMEDICARE SOLE PROP. PIN
WVCH4116691Medicare PIN