Provider Demographics
NPI:1144253394
Name:ALVIS, AMY BETH (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:ALVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1300
Mailing Address - Country:US
Mailing Address - Phone:276-322-5400
Mailing Address - Fax:276-322-5557
Practice Address - Street 1:231 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2002
Practice Address - Country:US
Practice Address - Phone:276-322-5400
Practice Address - Fax:276-322-5557
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV277363A00000X
VA0110001533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P89285Medicare UPIN
WVALPA21045Medicare PIN
WVPA21041Medicare PIN
VA00V443A34Medicare PIN
VAP00032007Medicare PIN
VAC08734Medicare PIN
WVP00013172Medicare PIN