# MOUNTAINEER FAMILY MEDICINE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295874436
- **Authorized official:** MOHAMAD SAMAH KALOU MD (OWNER)
- **Authorized official phone:** (304) 767-7840

## Contact information

- **Practice address:** 500 POPLAR ST, SUITE 204, CHARLESTON, WV 25309-1474
- **Practice address phone:** (304) 767-7840
- **Practice address fax:** (304) 767-7849
- **Mailing address:** PO BOX 11908, CHARLESTON, WV 25339-1908
- **Mailing address phone:** (304) 767-7840
- **Mailing address fax:** (304) 767-7849

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 22493 | WV | Yes |

## Other

- **Enumeration date:** 02/05/2007
- **Last updated:** 02/04/2008