| NPI | 1154429041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH MATUSIC Physician 304-343-1863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 731) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 1451) |
| 208000000X Pediatrics (Licence: WV 15140) | |
| 208000000X Pediatrics (Licence: WV 18217) | |
| 208000000X Pediatrics (Licence: WV 16381) | |
| 291U00000X Clinical Medical Laboratory (Licence: WV 51D0910134) | |
| 363L00000X Nurse Practitioner (Licence: WV 18804) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2011-06-23 |