Provider Demographics
NPI:1265482566
Name:DOCTORS HOUSE PLLC
Entity Type:Organization
Organization Name:DOCTORS HOUSE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CASTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-729-0015
Mailing Address - Street 1:612 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:ST. ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2858
Mailing Address - Country:US
Mailing Address - Phone:304-729-0015
Mailing Address - Fax:304-729-0016
Practice Address - Street 1:612 5TH STREET
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2858
Practice Address - Country:US
Practice Address - Phone:304-729-0015
Practice Address - Fax:304-729-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9359171Medicare PIN