Provider Demographics
NPI:1124297346
Name:CENTRAL WV MEDCORP, INC
Entity type:Organization
Organization Name:CENTRAL WV MEDCORP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PICCIRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-636-7451
Mailing Address - Street 1:P.O. BOX 2630
Mailing Address - Street 2:CENTRAL WV MEDCORP, INC.
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2630
Mailing Address - Country:US
Mailing Address - Phone:304-637-3799
Mailing Address - Fax:304-637-3369
Practice Address - Street 1:11 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2231
Practice Address - Country:US
Practice Address - Phone:304-472-4968
Practice Address - Fax:304-472-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0009078001Medicaid
WV51D0915651OtherCLIA NUMBERS
WV51D1062732OtherCLIA NUMBER
WV51D1017352OtherCLIA NUMBER
WV51D1061952OtherCLIA NUMBER
WV51D1070912OtherCLIA NUMBER
WV51D1082791OtherCLIA NUMBER