Provider Demographics
NPI:1972687705
Name:MORGANTOWN INTERNAL MEDICINE GROUP INC
Entity Type:Organization
Organization Name:MORGANTOWN INTERNAL MEDICINE GROUP INC
Other - Org Name:CONSULTANTS ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-599-8802
Mailing Address - Street 1:300 WEDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2452
Mailing Address - Country:US
Mailing Address - Phone:304-599-8802
Mailing Address - Fax:304-599-5607
Practice Address - Street 1:300 WEDGEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2452
Practice Address - Country:US
Practice Address - Phone:304-599-8802
Practice Address - Fax:304-599-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0011375000Medicaid
WV000454196OtherBC BS
WV0011375000Medicaid