Provider Demographics
NPI:1598939944
Name:1 FIT DOC PLLC
Entity Type:Organization
Organization Name:1 FIT DOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-792-6275
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-0239
Mailing Address - Country:US
Mailing Address - Phone:304-792-6275
Mailing Address - Fax:304-792-6295
Practice Address - Street 1:306 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3142
Practice Address - Country:US
Practice Address - Phone:304-792-6275
Practice Address - Fax:304-792-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV002024474OtherMOUNTAIN STATE BCBS
WV3810011557Medicaid
WV002024474OtherMOUNTAIN STATE BCBS
WV9375001Medicare PIN