Provider Demographics
NPI:1588747166
Name:NABIL GUIRGUIS
Entity type:Organization
Organization Name:NABIL GUIRGUIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUIRGUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBBCH
Authorized Official - Phone:304-629-9399
Mailing Address - Street 1:166 THOMPSON DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1644
Mailing Address - Country:US
Mailing Address - Phone:304-842-5668
Mailing Address - Fax:304-842-3113
Practice Address - Street 1:166 THOMPSON DR
Practice Address - Street 2:SUITE B
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1644
Practice Address - Country:US
Practice Address - Phone:304-842-5668
Practice Address - Fax:304-842-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001934214OtherBLUE CROSS
WV001934214OtherBLUE CROSS
WV512526Medicare Oscar/Certification