| NPI | 1205801396 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY-BETH BRUBECK Vice President Of Finance / CFO 304-525-3334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WV 21985) |
| 103T00000X Psychologist | |
| 122300000X Dentist (Licence: WV 3487) | |
| 207Q00000X Family Medicine (Licence: WV 19741) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2022-03-31 |