# CHUA FAMILY PRACTICE, PLLC

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

## Provider details

- **NPI number:** 1700948239
- **Authorized official:** MRS. CONNIE M BROWN RN (OFFICE MANAGER)
- **Authorized official phone:** (304) 637-0433

## Contact information

- **Practice address:** 1092 HARRISON AVE, ELKINS, WV 26241-3671
- **Practice address phone:** (304) 637-0433
- **Practice address fax:** (304) 637-0435
- **Mailing address:** PO BOX 490, ELKINS, WV 26241-0490
- **Mailing address phone:** (304) 637-0433
- **Mailing address fax:** (304) 637-0435

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | WV1833 | WV | — |
| 207Q00000X | Family Medicine Physician | WV1965 | WV | Yes |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3810004769 | — | WV |
| 01 | — | P00012945 | RR MEDICARE | WV |
| 01 | — | P00118111 | RR MEDICARE | WV |