=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699821702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHTON MEDICAL ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 09/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1097 FLEDDERJOHN RD
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25314-4208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-345-3627
-----------------------------------------------------
Fax | 304-346-4440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1097 FLEDDERJOHN RD
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25314-4208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-345-3627
-----------------------------------------------------
Fax | 304-346-4440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD ALLEN CAPITO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 304-345-3627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------