Provider Demographics
NPI:1992569867
Name:UNITED BODY MODS
Entity type:Organization
Organization Name:UNITED BODY MODS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:304-578-9503
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:MABSCOTT
Mailing Address - State:WV
Mailing Address - Zip Code:25871-0379
Mailing Address - Country:US
Mailing Address - Phone:304-578-9503
Mailing Address - Fax:
Practice Address - Street 1:1002 NEVILLE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4324
Practice Address - Country:US
Practice Address - Phone:304-578-9503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)