Provider Demographics
NPI:1497739346
Name:WV MEDICAL SERVICES PC
Entity type:Organization
Organization Name:WV MEDICAL SERVICES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:205-750-0030
Mailing Address - Street 1:4280 WATERMELON RD STE 112
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5250
Mailing Address - Country:US
Mailing Address - Phone:205-750-0030
Mailing Address - Fax:205-750-0855
Practice Address - Street 1:4280 WATERMELON RD STE 112
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5250
Practice Address - Country:US
Practice Address - Phone:205-750-0030
Practice Address - Fax:205-750-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019352207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51504044OtherBCBS
AL529912100Medicaid
AL51504044OtherBCBS