Provider Demographics
NPI:1538243852
Name:DRS DEWITT & GIBSON, PLLC
Entity type:Organization
Organization Name:DRS DEWITT & GIBSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HYLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-766-8558
Mailing Address - Street 1:506 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1204
Mailing Address - Country:US
Mailing Address - Phone:304-766-8558
Mailing Address - Fax:304-766-8561
Practice Address - Street 1:506 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1204
Practice Address - Country:US
Practice Address - Phone:304-766-8558
Practice Address - Fax:304-766-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0010406000Medicaid