Provider Demographics
NPI:1922423292
Name:GYNECOLOGIC ASSOCIATES OF PARKERSBURG, INC.
Entity Type:Organization
Organization Name:GYNECOLOGIC ASSOCIATES OF PARKERSBURG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-424-2035
Mailing Address - Street 1:705 GARFIELD AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5444
Mailing Address - Country:US
Mailing Address - Phone:304-485-4700
Mailing Address - Fax:304-485-4466
Practice Address - Street 1:705 GARFIELD AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5444
Practice Address - Country:US
Practice Address - Phone:304-424-2035
Practice Address - Fax:304-424-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810007580Medicaid