Provider Demographics
NPI:1306924279
Name:GRECO OSTEOPATHIC MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:GRECO OSTEOPATHIC MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-234-8885
Mailing Address - Street 1:PO BOX 6273
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-234-8885
Mailing Address - Fax:304-234-8426
Practice Address - Street 1:2115 CHAPLINE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-234-8885
Practice Address - Fax:304-234-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0009074000Medicaid
GR9268431Medicare ID - Type Unspecified