Provider Demographics
NPI:1639305857
Name:FAMILY MEDICINE OF PARKERSBURG INC
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF PARKERSBURG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHESNUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-485-4870
Mailing Address - Street 1:2601 DUDLEY AVE STE 5A
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2649
Mailing Address - Country:US
Mailing Address - Phone:304-485-4870
Mailing Address - Fax:304-485-4871
Practice Address - Street 1:2601 DUDLEY AVE STE 5A
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2649
Practice Address - Country:US
Practice Address - Phone:304-485-4870
Practice Address - Fax:304-485-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2980163Medicaid
WV3810015097Medicaid
WV9383121Medicare PIN