| NPI | 1174803027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA RUMBLE Provider Enrollment Specialist 304-285-7101 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine |
| 207Q00000X Family Medicine | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2014-05-22 |