=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700196615
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOMAS E. VIGO PAREDES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2010
-----------------------------------------------------
Last Update Date | 04/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 SHAE AVE
-----------------------------------------------------
City | CHAPMANVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25508-9805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-855-2211
-----------------------------------------------------
Fax | 304-855-2213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 132 GILCHRIST AVE
-----------------------------------------------------
City | TORNADO
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25202-9640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-756-3143
-----------------------------------------------------
Fax | 304-756-3143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TOMAS E. VIGO PAREDES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 304-756-3143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 17682
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------