Basic Information
| Provider Information | |||||||||
| NPI: | 1578556577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAXE MEDICAL SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CHATEAU LN | ||||||||
| Address2: | |||||||||
| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255041627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047364700 | ||||||||
| FaxNumber: | 3047364029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CHATEAU LN | ||||||||
| Address2: | |||||||||
| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255041627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047364700 | ||||||||
| FaxNumber: | 3047364029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 07/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | WOOTEN | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3047364744 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0008723000 | 05 | WV | MEDICAID | 0008723001 | 05 | WV | MEDICAID | 0117420 | 05 | OH | MEDICAID |