Organization
FAIRMONT GENERAL MDGRP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J SENGEWALT (SENIOR VP AND CFO)
(304) 367-7152
Entity
Organization
Contact information
Practice address
1325 LOCUST AVE, FAIRMONT, WV 26554-1435
(304) 367-7100
(304) 333-2617
Mailing address
1325 LOCUST AVE, FAIRMONT, WV 26554-1435
(304) 367-7100
(304) 333-2617
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001118003
—
WV
Enumeration date
11/07/2007
Last updated
11/07/2007
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