# JUSTICE MEDICAL COMPLEX

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

## Provider details

- **NPI number:** 1356426944
- **Authorized official:** DEBRA JUSTICE (OWNER)
- **Authorized official phone:** (304) 393-4004

## Contact information

- **Practice address:** RR BOX 330 US HWY 52, KERMIT, WV 25669
- **Practice address phone:** (304) 393-4004
- **Practice address fax:** (304) 393-4167
- **Mailing address:** PO BOX 837, KERMIT, WV 25674-0837
- **Mailing address phone:** (304) 393-4004
- **Mailing address fax:** (304) 393-4167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 21730 | WV | Yes |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3810004168 | — | WV |
| 05 | — | 65944621 | — | KY |