# COAL COUNTRY CLINIC INC

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

## Provider details

- **NPI number:** 1831379338
- **Authorized official:** DR. MICHAEL MERRITT KOSTENKO D.O. (PRESIDENT)
- **Authorized official phone:** (304) 763-0199

## Contact information

- **Practice address:** 3050 C AND O DAM RD, DANIELS, WV 25832-9718
- **Practice address phone:** (304) 763-0199
- **Practice address fax:** (304) 763-2137
- **Mailing address:** PO BOX 88, DANIELS, WV 25832-0088
- **Mailing address phone:** (304) 763-0199
- **Mailing address fax:** (304) 763-2137

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 1078 | WV | Yes |

## Other

- **Enumeration date:** 11/13/2007
- **Last updated:** 11/13/2007