Provider Demographics
NPI:1285813428
Name:NEIGHBORHOOD FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:NEIGHBORHOOD FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-637-8907
Mailing Address - Street 1:630 ROBERT E LEE AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3211
Mailing Address - Country:US
Mailing Address - Phone:304-637-8907
Mailing Address - Fax:304-637-3592
Practice Address - Street 1:630 ROBERT E LEE AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3211
Practice Address - Country:US
Practice Address - Phone:304-637-8907
Practice Address - Fax:304-637-3592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 1917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDB5584OtherRAILROAD MEDICARE
WV3810011254Medicaid
WV=========OtherTAX ID
WVDB5584OtherRAILROAD MEDICARE
WV=========OtherTRICARE