Provider Demographics
NPI:1629155791
Name:APGAR FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:APGAR FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:APGAR
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-633-7724
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25719-1895
Mailing Address - Country:US
Mailing Address - Phone:304-736-6262
Mailing Address - Fax:304-553-0250
Practice Address - Street 1:7743 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7822
Practice Address - Country:US
Practice Address - Phone:304-894-3287
Practice Address - Fax:304-553-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0008024000Medicaid
OH0962114Medicaid
OH0962114Medicaid
OH9926483Medicare Oscar/Certification