| Tg Medina Inc. | |
|
2 Chenoweth Dr Ste A Bridgeport WV 26330-1688 | |
| (304) 842-5449 | |
| (304) 842-5440 |
| Full Name | Tg Medina Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2 Chenoweth Dr Ste A, Bridgeport, West Virginia |
| Authorized Official Name and Position | Teodoro G Medina (PRESIDENT) |
| Authorized Official Contact | 3048425449 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tg Medina Inc. 2 Chenoweth Dr Ste A Bridgeport WV 26330-1688 Ph: (304) 842-5449 | Tg Medina Inc. 2 Chenoweth Dr Ste A Bridgeport WV 26330-1688 Ph: (304) 842-5449 |
| NPI Number | 1942343884 |
|---|---|
| Provider Enumeration Date | 02/14/2007 |
| Last Update Date | 11/20/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942343884 | NPI | - | NPPES |
| 3810010371 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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