Provider Demographics
NPI:1841060712
Name:BILLITER, GARY L
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:BILLITER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PADEN CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26159-1903
Mailing Address - Country:US
Mailing Address - Phone:330-701-3300
Mailing Address - Fax:
Practice Address - Street 1:715 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:PADEN CITY
Practice Address - State:WV
Practice Address - Zip Code:26159-1903
Practice Address - Country:US
Practice Address - Phone:330-701-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1356607394Medicaid
WV125553494Medicaid
WV1821206228Medicaid