1720472749 NPI number — VINCENT GERARD STILGER HSD, ATC

Table of content: VINCENT GERARD STILGER HSD, ATC (NPI 1720472749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720472749 NPI number — VINCENT GERARD STILGER HSD, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILGER
Provider First Name:
VINCENT
Provider Middle Name:
GERARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HSD, ATC
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:
1720472749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 S PIERPONT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26508-4147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-594-0237
Provider Business Mailing Address Fax Number:
304-293-4641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 BIRCH ST
Provider Second Line Business Practice Location Address:
WEST VIRGINIA UNIVERSITY
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-3418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-293-0872
Provider Business Practice Location Address Fax Number:
304-293-4641
Provider Enumeration Date:
03/27/2015

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: 2083S0010X , with the licence number:  AT001031 , 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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