Organization
MED EX PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD JAY BLACKBURN DO (OWNER)
(304) 868-6000
Entity
Organization
Contact information
Practice address
705 WASHINGTON ST, RAVENSWOOD, WV 26164-1729
(304) 868-6000
(304) 868-6002
Mailing address
705 WASHINGTON ST, RAVENSWOOD, WV 26164-1729
(800) 824-2543
(304) 485-4466
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
1455
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009472
—
WV
Enumeration date
06/05/2014
Last updated
06/05/2014
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