Healthcare Provider Details

I. General information

NPI: 1518970243
Provider Name (Legal Business Name): ALLEGHANY MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 GREENBIER ST
RUPERT WV
25984
US

IV. Provider business mailing address

310 GEORGE ST
BECKLEY WV
25801-2653
US

V. Phone/Fax

Practice location:
  • Phone: 304-392-5381
  • Fax: 304-392-5351
Mailing address:
  • Phone: 304-254-9022
  • Fax: 304-254-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: J JORGE GORDINHO
Title or Position: SUPERVISOR PHYSICIAN OWNER
Credential: MD
Phone: 304-254-9022