Provider Demographics
NPI:1154387223
Name:PARKERSBURG FAMILY MED ASSOC PLLC
Entity type:Organization
Organization Name:PARKERSBURG FAMILY MED ASSOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:SPYCHALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-424-4870
Mailing Address - Street 1:600 18TH ST
Mailing Address - Street 2:SUITE 611
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3231
Mailing Address - Country:US
Mailing Address - Phone:304-424-4870
Mailing Address - Fax:304-424-4090
Practice Address - Street 1:600 18TH ST
Practice Address - Street 2:SUITE 611
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3231
Practice Address - Country:US
Practice Address - Phone:304-424-4870
Practice Address - Fax:304-424-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2368692Medicaid
WVDA6867Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OH2368692Medicaid