MEDICARE: WILFREDO N. MOLANO MDSC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	10473	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8802214	OTHER	WV	MEDICARE

General Provider Information

NPI Number	:	1144317082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILFREDO N. MOLANO MDSC INC

Provider Business Mailing Address
First Line	:	PO BOX 428
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526
Country	:	US
Telephone Number	:	304-562-3331
Fax Number	:	304-562-3364

Provider Business Practice Location Address
First Line	:	2733 MAIN ST
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-1420
Country	:	US
Telephone Number	:	304-562-3331
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/ADMINISTRATOR
Name	:	DR. WILFREDO NAVA MOLANO
Credential	:	M.D.
Telephone Number	:	304-562-3331

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	03/12/2008

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