Provider Demographics
NPI:1497891220
Name:PRIORITY CARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:PRIORITY CARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-598-2632
Mailing Address - Street 1:918 CHESTNUT RIDGE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2822
Mailing Address - Country:US
Mailing Address - Phone:304-598-2632
Mailing Address - Fax:304-599-1952
Practice Address - Street 1:918 CHESTNUT RIDGE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2822
Practice Address - Country:US
Practice Address - Phone:304-598-2632
Practice Address - Fax:304-599-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV709111N00000X
WVWV126172081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty