Provider Demographics
NPI:1851473508
Name:KANAWHA VALLEY GASTROENTEROLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:KANAWHA VALLEY GASTROENTEROLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, DIRECTOR, SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-766-4342
Mailing Address - Street 1:4607 MACCORKLE AVE SW STE 406
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1364
Mailing Address - Country:US
Mailing Address - Phone:304-766-4342
Mailing Address - Fax:304-766-3541
Practice Address - Street 1:4607 MACCORKLE AVE SW STE 406
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-766-4342
Practice Address - Fax:304-766-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003017Medicaid
WV9353761OtherGROUP MEDICARE
WVKA9353761Medicare ID - Type Unspecified
WVC68918Medicare UPIN
WVG91325Medicare UPIN
WV3810003017Medicaid
WV9353761OtherGROUP MEDICARE