Provider Demographics
NPI:1881762276
Name:HUNTINGTON BEHAVIORAL MEDICINE
Entity type:Organization
Organization Name:HUNTINGTON BEHAVIORAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-757-5877
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-757-5877
Mailing Address - Fax:304-757-5878
Practice Address - Street 1:5960 ROUTE 60 EAST
Practice Address - Street 2:SUITE 2
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-757-5877
Practice Address - Fax:304-757-5878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV168142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0789723Medicare PIN
0789722Medicare PIN