Provider Demographics
NPI:1558565978
Name:RALEIGH ORTHOPEDIC CENTER PLLC
Entity Type:Organization
Organization Name:RALEIGH ORTHOPEDIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCIBETTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:304-255-3150
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0810
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:1007 S OAKWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5935
Practice Address - Country:US
Practice Address - Phone:304-255-3150
Practice Address - Fax:304-255-3151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2232207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810014052Medicaid
WV9369691Medicare PIN
WV3810014052Medicaid