Provider Demographics
NPI:1689982696
Name:SAMIR SHAH ECPWV LLC
Entity Type:Organization
Organization Name:SAMIR SHAH ECPWV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:304-760-6131
Mailing Address - Street 1:101 CARRIAGE WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-1526
Mailing Address - Country:US
Mailing Address - Phone:304-760-6131
Mailing Address - Fax:304-760-6134
Practice Address - Street 1:101 CARRIAGE WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-1526
Practice Address - Country:US
Practice Address - Phone:304-760-6131
Practice Address - Fax:304-760-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23485207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9392421Medicare PIN