Provider Demographics
NPI:1336369941
Name:IRVIN JOHN SNYDER
Entity type:Organization
Organization Name:IRVIN JOHN SNYDER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IRVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-372-7617
Mailing Address - Street 1:174 PINNELL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-9103
Mailing Address - Country:US
Mailing Address - Phone:304-372-7617
Mailing Address - Fax:304-372-7619
Practice Address - Street 1:174 PINNELL ST
Practice Address - Street 2:SUITE A
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9103
Practice Address - Country:US
Practice Address - Phone:304-372-7617
Practice Address - Fax:304-372-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0046068000Medicaid
WVSP03851Medicare PIN
WVG09742Medicare UPIN
WV0046068000Medicaid