Provider Demographics
NPI:1790116341
Name:ASSOCIATED SPECIALISTS, INC
Entity Type:Organization
Organization Name:ASSOCIATED SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:304-933-3800
Mailing Address - Street 1:527 MEDICAL PARK DR STE 204
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9009
Mailing Address - Country:US
Mailing Address - Phone:304-933-3800
Mailing Address - Fax:304-933-3815
Practice Address - Street 1:527 MEDICAL PARK DR STE 204
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9009
Practice Address - Country:US
Practice Address - Phone:304-933-3800
Practice Address - Fax:304-933-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55-0532650174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0092785001Medicaid
WV3810022789Medicaid
WV3810023280Medicaid
WV0076674000Medicaid
WV0128388000Medicaid
WV3810023284Medicaid
WV3810023285Medicaid
WV2006875000Medicaid
WV0080399000Medicaid
WV3810016091Medicaid
WV0640002000Medicaid
WV3810000654Medicaid
WV3810023454Medicaid