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NPI Code Detail

MEDICARE: MRS. AMY L. RALSTON

MEDICARE: MRS. AMY L. RALSTON
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
1104100000XSocial WorkerBP00939521WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001718899OTHERWVMSBCBS ID NUMBER
22070076OTHERWVCIGNA ID NUMBER
3276942000OTHERWVMAGELLAN ID NUMBER
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5Y525231OTHERWVHEALTH PLAN ID NUMBER

General Provider Information

NPI Number : 1225197288
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY L. RALSTON
Provider Business Mailing Address
First Line : 501 COLLIERS WAY
Second Line :
City : WEIRTON
State : WV
Zip : 26062-5003
Country : US
Telephone Number : 304-723-5440
Fax Number : 304-723-0665
Provider Business Practice Location Address
First Line : 501 COLLIERS WAY
Second Line :
City : WEIRTON
State : WV
Zip : 26062-5003
Country : US
Telephone Number : 304-723-5440
Fax Number : 304-723-0665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 05/26/2010

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Directions to “ MRS. AMY L. RALSTON ” Practice Location

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