Provider Demographics
NPI:1346431848
Name:AMERICAN MEDICAL, INC
Entity Type:Organization
Organization Name:AMERICAN MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:304-682-4989
Mailing Address - Street 1:127 COOK PARKWAY
Mailing Address - Street 2:PO BOX 1870
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-1870
Mailing Address - Country:US
Mailing Address - Phone:304-682-4989
Mailing Address - Fax:304-682-4989
Practice Address - Street 1:214 MORAN AVE
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882-0214
Practice Address - Country:US
Practice Address - Phone:304-294-4989
Practice Address - Fax:304-294-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2003-2597332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010265Medicaid
WV4871650002Medicare NSC