Provider Demographics
NPI:1679578751
Name:PACK, JOE M (DO)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:M
Last Name:PACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:5 E ALVON ROAD, SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:JACKSON RIVER ORTHOPEDICS
Practice Address - Street 2:1 ARH LANE, STE 102
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-862-6777
Practice Address - Fax:540-863-9167
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201406207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200026OtherLUNG
VA541839718104OtherBS MOUNTAIN STATE
WV465499OtherANTHEM
541839718OtherC&O
7194496OtherAETNA
213824OtherCARELINK
WV3003781000Medicaid
213824OtherSOUTHERN HEALTH
5431529OtherCCN
VA465498OtherANTHEM
VA006409806Medicaid
WV54183971800OtherWV WORKERS COMPENSATION
WV541839718103OtherBS MOUNTAIN STATE
VA541839718104OtherBS MOUNTAIN STATE
1200890004Medicare ID - Type UnspecifiedADMINSTAR FEDERAL
200026OtherLUNG
7194496OtherAETNA
VA465498OtherANTHEM
WV3003781000Medicaid