Provider Demographics
NPI:1376504423
Name:PARKERSBURG PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:PARKERSBURG PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-865-7700
Mailing Address - Street 1:3 ROSEMAR CIR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1203
Mailing Address - Country:US
Mailing Address - Phone:304-865-7700
Mailing Address - Fax:304-865-7703
Practice Address - Street 1:3 ROSEMAR CIR
Practice Address - Street 2:SUITE D
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1203
Practice Address - Country:US
Practice Address - Phone:304-865-7700
Practice Address - Fax:304-865-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0011101000Medicaid
OH2063216Medicaid
WVCN9317Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OH2063216Medicaid