=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023103892
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD F TERRY MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 01/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 PARK VIEW LN STE 202
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003-5406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-242-4700
-----------------------------------------------------
Fax | 304-242-7012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 PARK VIEW LN STE 202
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003-5406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-242-4700
-----------------------------------------------------
Fax | 304-242-7012
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SUPERVISOR
-----------------------------------------------------
Name | MS. TAMMY P. TURKALY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-242-4700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 9894
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------