MEDICARE: TOMAS E. VIGO PAREDES PLLC

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	261QP2300X	Primary Care Clinic/Center	17682	WV

General Provider Information

NPI Number	:	1700196615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMAS E. VIGO PAREDES PLLC

Provider Business Mailing Address
First Line	:	132 GILCHRIST AVE
Second Line	:
City	:	TORNADO
State	:	WV
Zip	:	25202-9640
Country	:	US
Telephone Number	:	304-756-3143
Fax Number	:	304-756-3143

Provider Business Practice Location Address
First Line	:	40 SHAE AVE
Second Line	:
City	:	CHAPMANVILLE
State	:	WV
Zip	:	25508-9805
Country	:	US
Telephone Number	:	304-855-2211
Fax Number	:	304-855-2213

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TOMAS E. VIGO PAREDES
Credential	:	M.D.
Telephone Number	:	304-756-3143

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	04/01/2011

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