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FORT ASHBY FAMILY PRACTICE
NPI 1104962729
Family Medicine - Adult Medicine in Fort Ashby, WV

Active since January 30, 2007
70 PRESIDENTS STREET, UNIT 1150, FORT ASHBY, WV 26719(304) 298-3605(304) 298-3578 Get Directions Write a Review

NPPES record last updated: November 1, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 1, 2016, Oct 10, 2016 (2 updates tracked since 2016).

About Fort Ashby Family Practice NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FORT ASHBY FAMILY PRACTICE (NPI 1104962729) is a healthcare organization registered as an adult medicine in Fort Ashby, West Virginia and active in the NPI registry since January 2007. The organization lists Paul Taylor Livengood, Owner, as its authorized official.

NPPES Registry Identity

NPI1104962729
Entity TypeOrganization
Primary Taxonomy207QA0505X
Legal Business NameBRADDOCK MEDICAL GROUP P.A.
Location Address70 PRESIDENTS STREET, UNIT 1150Fort Ashby, WV 26719-1150
Mailing Address70 Presidents StreetFort Ashby, WV 26719-1150 · (304) 298-3605 · Fax (304) 298-3578
Phone(304) 298-3605
Fax(304) 298-3578
Organization SubpartYesParent: Braddock Medical Group Pa
Authorized OfficialPaul Taylor LivengoodOwner · (304) 298-3605
Enumeration DateJanuary 30, 2007
Last NPPES UpdateNovember 1, 20162 updates tracked since enumeration
✔ NPI 1104962729 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
License✔ Licensed in WV · 11172
Definition
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.
70 PRESIDENTS STREET, Fort Ashby, WV 26719
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Other Names 1

Other NameFort Ashby Family Practice

Other Identifiers 9

Other41707101MD · Bcbs Provider #
Medicaid3810000010WV
Other850-290Mamsi Mdipa Optimum
Other00716943WV · Bcbs Provider #
OtherH529BRMD · Bcbs Group #
OtherW399Bcbs Federal Provider #
Medicare UPINA72055WV
Other0003Bcbs Federal Group #
Medicaid0056043000WV

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Braddock Medical Group P.A.'s NPI number?

The NPI number for Braddock Medical Group P.A. is 1104962729. It was assigned to this organization in the NPPES registry on January 30, 2007. The provider is also known as Fort Ashby Family Practice.

Where is Braddock Medical Group P.A. located?

Braddock Medical Group P.A. is located at 70 Presidents Street Unit 1150, Fort Ashby, WV 26719. The listed phone number is (304) 298-3605.

What is Braddock Medical Group P.A.'s specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

When was this NPI record last updated?

The NPPES record for Braddock Medical Group P.A. was last updated on November 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.