Provider Demographics
NPI:1346370350
Name:DOCTORS QUICK CARE
Entity Type:Organization
Organization Name:DOCTORS QUICK CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAUDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-623-6300
Mailing Address - Street 1:RT 2 BOX 900
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9680
Mailing Address - Country:US
Mailing Address - Phone:304-623-6300
Mailing Address - Fax:304-623-1006
Practice Address - Street 1:429 SMITHFIELD ST
Practice Address - Street 2:
Practice Address - City:ANMOORE
Practice Address - State:WV
Practice Address - Zip Code:26323
Practice Address - Country:US
Practice Address - Phone:304-623-6300
Practice Address - Fax:304-623-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0045383000Medicaid
WV0045383000Medicaid
WV9293591Medicare PIN