Provider Demographics
NPI:1801050687
Name:ANGER FAMILY PRACTICE, PLLC
Entity type:Organization
Organization Name:ANGER FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-636-0133
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:ANGER FAMILY PRACTICE, PLLC
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0029
Mailing Address - Country:US
Mailing Address - Phone:304-637-3439
Mailing Address - Fax:304-637-3435
Practice Address - Street 1:62 BARNARD AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3150
Practice Address - Country:US
Practice Address - Phone:304-636-0133
Practice Address - Fax:304-637-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61887208000000X
WV20931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV002051730OtherMOUNTAIN STATE BCBS PAY TO #
WV3810012616Medicaid
WVDO4248OtherRAILROAD MEDICARE
WV3810012616Medicaid
WV4112053Medicare PIN