Provider Demographics
NPI:1700196615
Name:TOMAS E. VIGO PAREDES PLLC
Entity Type:Organization
Organization Name:TOMAS E. VIGO PAREDES PLLC
Other - Org Name:VIGO FAMILY HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:VIGO PAREDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-756-3143
Mailing Address - Street 1:132 GILCHRIST AVE
Mailing Address - Street 2:
Mailing Address - City:TORNADO
Mailing Address - State:WV
Mailing Address - Zip Code:25202-9640
Mailing Address - Country:US
Mailing Address - Phone:304-756-3143
Mailing Address - Fax:304-756-3143
Practice Address - Street 1:40 SHAE AVE
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-9805
Practice Address - Country:US
Practice Address - Phone:304-855-2211
Practice Address - Fax:304-855-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17682261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care