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MANCHIN CLINIC SOUTH LLC NPI 1265605208


NPI Information

NPI: 1265605208
Provider Name: MANCHIN CLINIC SOUTH, LLC
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 51D1082418

Address:
181 MIDDLETOWN CIRCLE
FAIRMONT, WV
ZIP 26554
Phone: (304) 367-9170
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MANCHIN CLINIC SOUTH, LLC is a clinic center in Fairmont, WV. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). MANCHIN CLINIC SOUTH, LLC NPI is 1265605208. The provider is registered as an organization entity type.

The provider's business location address is:

181 MIDDLETOWN CIRCLE
FAIRMONT, WV
ZIP 26554
Phone: (304) 367-9170
Fax: (304) 367-9180

The provider's authorized official is John Manchin .
The authorized official title is Sole Member and has the following contact phone number (304) 367-9170.

The CLIA number assigned to this NPI record is 51D1082418 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 4/10/2008 and was last updated on 5/21/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261Q00000XClinic/CenterYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13810011616MEDICAIDWEST VIRGINIA
29375131MEDICARE PINWEST VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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