Organization
WVA DIABETIC SUPPLIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA MARIE PRICE (OWNER/MANAGER)
(304) 592-3340
Entity
Organization
Contact information
Practice address
409 S PIKE ST, SHINNSTON, WV 26431-1125
(304) 592-1870
(304) 592-1890
Mailing address
409 S PIKE ST, SHINNSTON, WV 26431-1125
(304) 592-1870
(304) 592-1890
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
2223-3336
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810015096
—
WV
Enumeration date
04/28/2009
Last updated
11/30/2012
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