| NPI | 1588422547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDI WHITE Provider Network Analyst 304-388-0266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 261QR0200X Clinic/Center Radiology | |
| 207T00000X Neurological Surgery | |
| 291U00000X Clinical Medical Laboratory | |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2024-03-13 |
| Last Update Date | 2024-11-04 |