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Contact Information

PEDIATRIC ASSOCIATE
11 CHENOWETH DR
SUITE A
BRIDGEPORT, WV26330-1675
 Phone: 304-842-5777
 Fax: 304-842-3318
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Legal Medicine

173000000X
Indicates primary specialty

NPI Profile & details for PEDIATRIC ASSOCIATE

NPI Number 1104937416
LBN Legal business name PEDIATRIC ASSOCIATE
Authorized official JOSEPH MOMEN - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/31/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
WV License # WV11941
WV Medicaid 0010556000
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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