Provider Demographics
NPI:1366406779
Name:STROW, MISTY K (MD)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:K
Last Name:STROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:723 9TH AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-529-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21504207P00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2807716Medicaid
KY10042570Medicaid
WVP00378448OtherMEDICARE-RR PROVIDER NUMBER
WV3810010692Medicaid
WV3810010692Medicaid
WVWV2478FMedicare PIN
WV7368891Medicare PIN
WVWV2478C197Medicare PIN
WVI71760Medicare UPIN
WVP00378448OtherMEDICARE-RR PROVIDER NUMBER
KY10042570Medicaid
WVWV2478DMedicare PIN
WVWV2478CMedicare PIN
WVWV2478AMedicare PIN
WVWV2478C455Medicare PIN
WVWV3414C895Medicare PIN
WVWV2478BMedicare PIN
WVWV2478Medicare PIN
WVWV2478C729Medicare PIN