1649471731 NPI number — SAM SKAFF ,MD,INC

Table of content: (NPI 1932300944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649471731 NPI number — SAM SKAFF ,MD,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAM SKAFF ,MD,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1649471731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40085
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25364-0085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-925-9225
Provider Business Mailing Address Fax Number:
304-925-5357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 MAC CORKLE AVENUE SOUTH EAST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25304-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-925-9225
Provider Business Practice Location Address Fax Number:
304-925-5357
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SKAFF
Authorized Official First Name:
SAM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-925-9225

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  18485 , 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)





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