Healthcare Provider Details

I. General information

NPI: 1467542183
Provider Name (Legal Business Name): ALWAHIDO MEDICAL CORPORATION M C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 STANAFORD RD
BECKLEY WV
25801-3145
US

IV. Provider business mailing address

PO BOX 299 STANAFORD MEDICAL CLINIC
STANAFORD WV
25927-0299
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-8227
  • Fax: 304-256-8214
Mailing address:
  • Phone: 304-256-8227
  • Fax: 304-256-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA ANN JAFARY
Title or Position: DIRECTOR OFFICE MANAGER
Credential:
Phone: 304-256-8227