Basic Information
Provider Information
NPI: 1285050708
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOUCK
FirstName: RICHARD
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2000 EOFF ST
Address2:  
City: WHEELING
State: WV
PostalCode: 260033823
CountryCode: US
TelephoneNumber: 3042340123
FaxNumber:  
Practice Location
Address1: 2000 EOFF ST
Address2:  
City: WHEELING
State: WV
PostalCode: 260033823
CountryCode: US
TelephoneNumber: 3042340123
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/07/2014
LastUpdateDate: 04/06/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/06/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XED0249CWVY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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