Basic Information
| Provider Information | |||||||||
| NPI: | 1003803891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLBERT | ||||||||
| FirstName: | CECIL | ||||||||
| MiddleName: | TODD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3 HEALTH CARE DRIVE | ||||||||
| Address2: | PO BOX 900 | ||||||||
| City: | PHILIPPI | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044572800 | ||||||||
| FaxNumber: | 3044574011 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 HEALTH CARE DRIVE | ||||||||
| Address2: | |||||||||
| City: | PHILIPPI | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044572800 | ||||||||
| FaxNumber: | 3044574011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 07/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | WV20262 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1003803891 | 05 | WV | MEDICAID | P00276759 | 01 | WV | RAILROAD MEDICARE | OTHER |