Provider Demographics
NPI:1881850592
Name:BILLIPS, RONALD WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WAYNE
Last Name:BILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3997 BECKLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-7660
Mailing Address - Country:US
Mailing Address - Phone:304-431-5499
Mailing Address - Fax:304-431-3400
Practice Address - Street 1:3016E CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4858
Practice Address - Country:US
Practice Address - Phone:304-431-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1346266848OtherGROUP NPI
WV1043387327OtherPRUDICH MEDICAL NPI
WV1881850592OtherMOUNTAIN STATE BC
WV0022360001Medicaid
WV9232183OtherAETNA
WV5118601Medicare Oscar/Certification