Provider Demographics
NPI:1730476938
Name:WEDGEWOOD FAMILY PRACTICE AND PSYCHIATRY ASSOC., INC
Entity Type:Organization
Organization Name:WEDGEWOOD FAMILY PRACTICE AND PSYCHIATRY ASSOC., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTHURS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-599-9400
Mailing Address - Street 1:613 BURROUGHS ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:613 BURROUGHS ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3332
Practice Address - Country:US
Practice Address - Phone:304-599-1975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSW051112434251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health