Provider Demographics
NPI:1326223819
Name:JOY E COUSINS D O CO
Entity Type:Organization
Organization Name:JOY E COUSINS D O CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:E
Authorized Official - Last Name:COUSINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-788-2800
Mailing Address - Street 1:1 GRAND CENTRAL PARK
Mailing Address - Street 2:SUITE 2060
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-3157
Mailing Address - Country:US
Mailing Address - Phone:304-788-2280
Mailing Address - Fax:
Practice Address - Street 1:1 GRAND CENTRAL PARK
Practice Address - Street 2:SUITE 2060
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-3157
Practice Address - Country:US
Practice Address - Phone:304-788-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1801456000Medicaid