Provider Demographics
NPI:1598829541
Name:AZZO ORTHOPEDICS, PLLC
Entity Type:Organization
Organization Name:AZZO ORTHOPEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WALID
Authorized Official - Middle Name:HIKMET
Authorized Official - Last Name:AZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MDPHD
Authorized Official - Phone:304-324-2725
Mailing Address - Street 1:PO BOX 1696
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1696
Mailing Address - Country:US
Mailing Address - Phone:304-324-2725
Mailing Address - Fax:304-324-2780
Practice Address - Street 1:512 CHERRY ST BLDG I
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3341
Practice Address - Country:US
Practice Address - Phone:304-324-2725
Practice Address - Fax:304-324-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0097968000Medicaid
WV1478158OtherUNITED MINE WORKERS
WV1478158OtherUNITED MINE WORKERS
WV=========001OtherBLUE CROSS MOUNTAIN STATE
WVCK4380Medicare PIN
VAC08831Medicare PIN
WV0097968000Medicaid
WV9327031Medicare PIN