Provider Demographics
NPI:1710023734
Name:JOHN P. RICHARDS, D.O.
Entity Type:Organization
Organization Name:JOHN P. RICHARDS, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-965-7051
Mailing Address - Street 1:4914 ELK RIVER RD STE A
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-9278
Mailing Address - Country:US
Mailing Address - Phone:304-965-7051
Mailing Address - Fax:304-965-5074
Practice Address - Street 1:4914 ELK RIVER RD STE A
Practice Address - Street 2:
Practice Address - City:ELKVIEW
Practice Address - State:WV
Practice Address - Zip Code:25071-9278
Practice Address - Country:US
Practice Address - Phone:304-965-7051
Practice Address - Fax:304-965-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1129204D00000X, 207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1025208OtherWORKERS COMPENSATION
WV0041905000Medicaid
WV205562OtherCARELINK COVENTRY
WV7152313OtherCIGNA
WV7152313OtherCIGNA
WV1025208OtherWORKERS COMPENSATION
WV=========OtherUNITED HEALTHCARE MAMSI