MEDICARE: SAMIR SHAH ECPWV LLC

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	207RC0000X	Cardiovascular Disease Physician	23485	WV

General Provider Information

NPI Number	:	1689982696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMIR SHAH ECPWV LLC

Provider Business Mailing Address
First Line	:	101 CARRIAGE WAY
Second Line	:	SUITE 103
City	:	HURRICANE
State	:	WV
Zip	:	25526-1526
Country	:	US
Telephone Number	:	304-760-6131
Fax Number	:	304-760-6134

Provider Business Practice Location Address
First Line	:	101 CARRIAGE WAY
Second Line	:	SUITE 103
City	:	HURRICANE
State	:	WV
Zip	:	25526-1526
Country	:	US
Telephone Number	:	304-760-6131
Fax Number	:	304-760-6134

Authorized Official
Title or Position	:	SENIOR BILLER
Name	:	TERESA SLATER
Credential	:	CPC
Telephone Number	:	304-760-6131

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	01/24/2011

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Directions to “SAMIR SHAH ECPWV LLC ” Practice Location

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