Provider Demographics
NPI:1992923734
Name:CENTER FOR ALTERNATIVE MEDICINE
Entity type:Organization
Organization Name:CENTER FOR ALTERNATIVE MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MACCALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-757-3368
Mailing Address - Street 1:300B PRESTIGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8419
Mailing Address - Country:US
Mailing Address - Phone:304-757-3368
Mailing Address - Fax:304-757-2402
Practice Address - Street 1:300B PRESTIGE PARK DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8419
Practice Address - Country:US
Practice Address - Phone:304-757-3368
Practice Address - Fax:304-757-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104630122084P0800X, 1041C0700X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710972OtherBLUE CROSS BLUE SHIELD
WV0116818000Medicaid
WV9309091Medicare PIN
WV001710972OtherBLUE CROSS BLUE SHIELD