Basic Information
| Provider Information | |||||||||
| NPI: | 1508866633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELLHAUS | ||||||||
| FirstName: | KURT | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 MORRIS ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253011326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043883574 | ||||||||
| FaxNumber: | 3043886481 | ||||||||
| Practice Location | |||||||||
| Address1: | 1738 LOUDON HEIGHTS RD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253141546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045469524 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 03/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 15554 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 15554 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207P00000X | 15554 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1000454000 | 05 | WV | MEDICAID | 1508866633 | 01 | WV | BLUE CROSS BLUE SHIELD | OTHER |