# CABIN CREEK HEALTH CENTER LAB

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

## Provider details

- **NPI number:** 1457754988
- **Authorized official:** JENNIFER RUSSELL (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (304) 734-2040

## Contact information

- **Practice address:** 5722 CABIN CREEK RD, DAWES, WV 25054
- **Practice address phone:** (304) 734-2040
- **Practice address fax:** (304) 734-2047
- **Mailing address:** PO BOX 70, DAWES, WV 25054-0070
- **Mailing address phone:** (304) 734-2040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/29/2014
- **Last updated:** 09/29/2014