Provider Demographics
NPI:1285904623
Name:INTERNAL MEDICINE OF WEST VIRGINIA, PLLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF WEST VIRGINIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-264-9837
Mailing Address - Street 1:1008 TAVERN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2801
Mailing Address - Country:US
Mailing Address - Phone:304-264-9837
Mailing Address - Fax:304-264-9838
Practice Address - Street 1:1008 TAVERN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2801
Practice Address - Country:US
Practice Address - Phone:304-264-9837
Practice Address - Fax:304-264-9838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV99SEV261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care