Provider Demographics
NPI:1699860676
Name:WVUH-EAST SERVICES INC
Entity type:Organization
Organization Name:WVUH-EAST SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-264-1358
Mailing Address - Street 1:2000 FOUNDATION WAY
Mailing Address - Street 2:STE 3400
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-264-1358
Mailing Address - Fax:
Practice Address - Street 1:2000 FOUNDATION WAY
Practice Address - Street 2:STE 3400
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9003
Practice Address - Country:US
Practice Address - Phone:304-264-1358
Practice Address - Fax:304-264-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034493000Medicaid
WV9305717Medicare PIN