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Contact Information

WILLO GROUP
460 E. MAIN STREET
BRIDGEPORT, WV26330
 Phone: 304-848-9500
 Fax: 304-848-9503
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for WILLO GROUP

NPI Number 1396176756
LBN Legal business name WILLO GROUP
Authorized official LORI SPATAFORE - (OWNER/MEMBER)
Entity Organization
Organization subpart 1 No
Enumeration date 12/10/2013
Last updated 04/30/2021 - About 5 years ago
Identifiers
WV License # SP0552461
WV Medicaid 3910001300
Other 2143725 PK
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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