1104823830 NPI number — MR. MICHAEL LEE BELCHER PA-C

Table of content: MR. MICHAEL LEE BELCHER PA-C (NPI 1104823830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104823830 NPI number — MR. MICHAEL LEE BELCHER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELCHER
Provider First Name:
MICHAEL
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104823830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX L-2667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43260-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-256-0770
Provider Business Mailing Address Fax Number:
304-256-0772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 GEORGE ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-256-0770
Provider Business Practice Location Address Fax Number:
304-256-0772
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  826 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com