MEDICARE: MINGO MEDICAL ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	12882	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134184229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINGO MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 728
Second Line	:
City	:	DELBARTON
State	:	WV
Zip	:	25670-0728
Country	:	US
Telephone Number	:	304-475-3334
Fax Number	:

Provider Business Practice Location Address
First Line	:	MAIN STREET
Second Line	:
City	:	DELBARTON
State	:	WV
Zip	:	25670
Country	:	US
Telephone Number	:	304-475-3334
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	DR. OSCAR P CARRILLO
Credential	:	M.D.
Telephone Number	:	304-475-3334

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	08/22/2020

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