Provider Demographics
NPI:1952472417
Name:ALLEGHANY MEDICAL SERVICES, PC
Entity Type:Organization
Organization Name:ALLEGHANY MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:GORDINHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-254-9022
Mailing Address - Street 1:310 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2653
Mailing Address - Country:US
Mailing Address - Phone:304-254-9022
Mailing Address - Fax:304-254-9024
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1211
Practice Address - Country:US
Practice Address - Phone:304-583-2464
Practice Address - Fax:304-583-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0072202000Medicaid
WV3810007534Medicaid
WVP00177367OtherRAILRAOD MEDICARE
WVCK7027OtherRAILROAD MEDICARE
WVCK7027OtherRAILROAD MEDICARE
WVP00177367OtherRAILRAOD MEDICARE
WV9319761Medicare PIN