Provider Demographics
NPI:1285013896
Name:DOCTORS SPECIALTY CARE
Entity Type:Organization
Organization Name:DOCTORS SPECIALTY CARE
Other - Org Name:ADDICTION CENTER OF WV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-623-6300
Mailing Address - Street 1:27 TROVATO ST,
Mailing Address - Street 2:SUITE NUMBER 103
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330
Mailing Address - Country:US
Mailing Address - Phone:304-623-6300
Mailing Address - Fax:304-623-6302
Practice Address - Street 1:27 TROVATO ST
Practice Address - Street 2:SUITE NUMBER 103
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-7002
Practice Address - Country:US
Practice Address - Phone:304-623-6300
Practice Address - Fax:304-623-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty