Provider Demographics
NPI:1184879660
Name:DRS SHARPS AND LOOPER OF FAIRMONT PLLC
Entity type:Organization
Organization Name:DRS SHARPS AND LOOPER OF FAIRMONT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHARPS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-368-9393
Mailing Address - Street 1:32 TYGART MALL LOOP
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-368-9393
Mailing Address - Fax:304-368-9008
Practice Address - Street 1:32 TYGART MALL LOOP
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-368-9393
Practice Address - Fax:304-368-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV727D305R00000X
WV726D305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9379731Medicare PIN
WVT32585Medicare UPIN
WVT32584Medicare UPIN