Healthcare Provider Details

I. General information

NPI: 1134193626
Provider Name (Legal Business Name): WILLIAM J MCINTYRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/13/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 MEDICAL CENTER BLVD
HAYSI VA
24256-0653
US

IV. Provider business mailing address

276 FIELDSTONE DR
JONESVILLE VA
24263-1215
US

V. Phone/Fax

Practice location:
  • Phone: 276-865-5121
  • Fax: 276-546-9707
Mailing address:
  • Phone: 276-546-5310
  • Fax: 276-546-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23810
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG54048
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101044775
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number12849
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD026082E
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number0101044775
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: