=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578675492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL A MUSCARI SR. DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 HOWARD AVENUE FAMILY HEALTHCARE ASSOC INC
-----------------------------------------------------
City | MULLENS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-294-4880
-----------------------------------------------------
Fax | 304-294-6480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1650 MAIN STREET FAMILY HEALTH CARE ASSOCIATES INC
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24874-1650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-732-6735
-----------------------------------------------------
Fax | 304-732-9218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 466
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------