Provider Demographics
NPI:1396845236
Name:EXEMPLAR, INC
Entity Type:Organization
Organization Name:EXEMPLAR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASSIST/CREDENTIALING SPECIAL
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-294-7001
Mailing Address - Street 1:100 AVERY OLIVIA WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9375
Mailing Address - Country:US
Mailing Address - Phone:304-363-7000
Mailing Address - Fax:304-363-7413
Practice Address - Street 1:153 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1714
Practice Address - Country:US
Practice Address - Phone:304-848-2400
Practice Address - Fax:304-848-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9372451Medicare PIN