Healthcare Provider Details

I. General information

NPI: 1366440661
Provider Name (Legal Business Name): SOPHIA A SIBOLD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA A SIMMS D.O.

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTH CENTER DRIVE
UNION WV
24983-0000
US

IV. Provider business mailing address

PO BOX 590
UNION WV
24983-0590
US

V. Phone/Fax

Practice location:
  • Phone: 304-772-3064
  • Fax: 304-772-3296
Mailing address:
  • Phone: 304-772-3064
  • Fax: 304-772-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2102
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: