Provider Demographics
NPI:1528089703
Name:PANHANDLE MEDICAL ASSOC PLLC
Entity type:Organization
Organization Name:PANHANDLE MEDICAL ASSOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RONK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-263-6997
Mailing Address - Street 1:65 HEALTH CARE LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4006
Mailing Address - Country:US
Mailing Address - Phone:304-263-6997
Mailing Address - Fax:304-263-8827
Practice Address - Street 1:65 HEALTH CARE LN
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4006
Practice Address - Country:US
Practice Address - Phone:304-263-6997
Practice Address - Fax:304-263-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1177170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0073644000Medicaid
WV0073644000Medicaid