MEDICARE: P AND P HEALTH SERVICES, 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	261QR0200X	Radiology Clinic/Center	4801	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	630001659	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FAC250G	OTHER		HEALTH PLAN (HMO)
2	001710535	OTHER	WV	MOUNTAIN STATE BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730332560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P AND P HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	26 SUN VLY
Second Line	:
City	:	GLEN DALE
State	:	WV
Zip	:	26038-1222
Country	:	US
Telephone Number	:	304-845-7528
Fax Number	:	304-845-5214

Provider Business Practice Location Address
First Line	:	1612 WHEELING AVE
Second Line	:
City	:	GLEN DALE
State	:	WV
Zip	:	26038-1734
Country	:	US
Telephone Number	:	304-280-4501
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	PATRICIA A MARONEY
Credential	:	R.T.
Telephone Number	:	304-845-7528

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	03/05/2012

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Directions to “P AND P HEALTH SERVICES, INC ” Practice Location

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