Provider Demographics
NPI:1124268560
Name:LEO P. PAJARILLO, M.D. INC.
Entity type:Organization
Organization Name:LEO P. PAJARILLO, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:PANTILLA
Authorized Official - Last Name:PAJARILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-235-5225
Mailing Address - Street 1:701 COLLEGE HILL
Mailing Address - Street 2:P.O. BOX 380
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3300
Mailing Address - Country:US
Mailing Address - Phone:304-235-5225
Mailing Address - Fax:304-235-5282
Practice Address - Street 1:701 COLLEGE HL
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3300
Practice Address - Country:US
Practice Address - Phone:304-235-5225
Practice Address - Fax:304-235-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0112030000Medicaid
KY64698426Medicaid