Provider Demographics
NPI:1194232801
Name:SOUTH BRANCH HOSPITALIST AND INTERNAL MEDICINE GROUP PLLC
Entity type:Organization
Organization Name:SOUTH BRANCH HOSPITALIST AND INTERNAL MEDICINE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-257-2527
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-0158
Mailing Address - Country:US
Mailing Address - Phone:304-257-2527
Mailing Address - Fax:304-257-1469
Practice Address - Street 1:65 HOSPITAL DR STE 102
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9549
Practice Address - Country:US
Practice Address - Phone:304-257-2527
Practice Address - Fax:304-257-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207R00000X, 208M00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0084630000Medicaid
WV3910007251Medicaid
WV0075837000Medicaid
WV3910000537Medicaid