Provider Demographics
NPI:1467542183
Name:ALWAHIDO MEDICAL CORPORATION M C
Entity Type:Organization
Organization Name:ALWAHIDO MEDICAL CORPORATION M C
Other - Org Name:STANAFORD MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JAFARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-256-8227
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:STANAFORD MEDICAL CLINIC
Mailing Address - City:STANAFORD
Mailing Address - State:WV
Mailing Address - Zip Code:25927-0299
Mailing Address - Country:US
Mailing Address - Phone:304-256-8227
Mailing Address - Fax:304-256-8214
Practice Address - Street 1:451 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3145
Practice Address - Country:US
Practice Address - Phone:304-256-8227
Practice Address - Fax:304-256-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002364Medicaid
WV3810002364Medicaid
9333221Medicare ID - Type UnspecifiedMEDICARE