Basic Information
| Provider Information | |||||||||
| NPI: | 1558565978 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RALEIGH ORTHOPEDIC CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 810 | ||||||||
| Address2: | |||||||||
| City: | WHITE SULPHUR SPRINGS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249860810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045365030 | ||||||||
| FaxNumber: | 3045365031 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 S OAKWOOD AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258015935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042553150 | ||||||||
| FaxNumber: | 3042553151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCIBETTA | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3042553150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2232 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3810014052 | 05 | WV | MEDICAID |