Provider Demographics
NPI:1386623783
Name:NEW CENTURY MEDICAL OBSERVATION SERVICES OF WEST VIRGINIA, INC
Entity type:Organization
Organization Name:NEW CENTURY MEDICAL OBSERVATION SERVICES OF WEST VIRGINIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:800-875-0136
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4366
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-4170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV150778001OtherFEDERAL BLACK LUNG
WV610274000OtherFECA
WV610274000OtherENERGY
WV7009670OtherAETNA
WV001762398OtherBLUE CROSS BLUE SHIELD
WV150778001OtherFECA
WV3810003355Medicaid
WV610274000OtherBLACK LUNG
WV3810003355Medicaid
WV=========026OtherCARESOURCE
WV7009670OtherAETNA
WV001762398OtherBLUE CROSS BLUE SHIELD
WV001762398OtherBLUE CROSS BLUE SHIELD
WV9351541Medicare PIN