Organization
WVUPC-KANAWHA VALLEY FAMILY PRACTICE
Active
Parent organization
WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION
Authorized official
ROBYN M MCDANIEL (PROVIDER RELATIONS SUPERVISOR)
(304) 293-5033
Entity
Organization
Contact information
Practice address
401 DIVISION ST, SUITE 205, S CHARLESTON, WV 25309-1455
(304) 768-3941
Mailing address
PO BOX 7000, MORGANTOWN, WV 26507-7000
(304) 293-7401
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4002106000
—
WV
Enumeration date
10/29/2008
Last updated
10/29/2008
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