Healthcare Provider Details

I. General information

NPI: 1184736126
Provider Name (Legal Business Name): ALLEGHANY MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2962 ROBERT C. BYRD DRIVE
BECKLEY WV
25801
US

IV. Provider business mailing address

2962 ROBERT C. BYRD DRIVE
BECKLEY WV
25801
US

V. Phone/Fax

Practice location:
  • Phone: 304-254-9022
  • Fax: 304-254-9024
Mailing address:
  • Phone: 304-254-9022
  • Fax: 304-254-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateWV

VIII. Authorized Official

Name: JOSE JORGE GORDINHO
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 304-254-9022