Healthcare Provider Details

I. General information

NPI: 1932230703
Provider Name (Legal Business Name): ISLAND MEDICAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S PENN ST
WHEELING WV
26003-2075
US

IV. Provider business mailing address

103 S PENN ST
WHEELING WV
26003-2075
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-2100
  • Fax: 304-232-8272
Mailing address:
  • Phone: 304-232-2100
  • Fax: 304-232-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8646
License Number StateWV

VIII. Authorized Official

Name: DR. BASIL P PAPADIMITRIOU
Title or Position: PRESIDENT
Credential: MD
Phone: 304-232-2100