Basic Information
Provider Information | |||||||||
NPI: | 1235104373 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LE NOACH | ||||||||
FirstName: | PHILIP | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 927 | ||||||||
Address2: | 5 E ALVON ROAD, SUITE 7 | ||||||||
City: | WHITE SULPHUR SPRINGS | ||||||||
State: | WV | ||||||||
PostalCode: | 249862373 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3045365030 | ||||||||
FaxNumber: | 3045365031 | ||||||||
Practice Location | |||||||||
Address1: | 800 OAK STREET | ||||||||
Address2: |   | ||||||||
City: | FARMVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 239011199 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4343152850 | ||||||||
FaxNumber: | 4343928191 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/22/2006 | ||||||||
LastUpdateDate: | 03/13/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/13/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0101235244 | VA | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 10039384 | 01 | VA | OPTIMA/SENTARA | OTHER | 4265678 | 01 | VA | CIGNA | OTHER | 010018242 | 05 | VA |   | MEDICAID | 3115917 | 01 | VA | UHC/MAMSI | OTHER |