Provider Demographics
NPI:1548878119
Name:ROSS, CODI
Entity type:Individual
Prefix:
First Name:CODI
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3109
Mailing Address - Country:US
Mailing Address - Phone:304-642-6366
Mailing Address - Fax:
Practice Address - Street 1:501 WILSON LN STE 3
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-5216
Practice Address - Country:US
Practice Address - Phone:304-636-9396
Practice Address - Fax:304-636-0719
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant