Healthcare Provider Details

I. General information

NPI: 1336487321
Provider Name (Legal Business Name): DHP OF FAIRMONT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 LOCUST AVE
FAIRMONT WV
26554-1435
US

IV. Provider business mailing address

PO BOX 638073
CINCINNATI OH
45263-8073
US

V. Phone/Fax

Practice location:
  • Phone: 304-333-8305
  • Fax: 919-655-1330
Mailing address:
  • Phone: 330-470-3700
  • Fax: 330-497-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDAL DABBS
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 865-693-1000