Organization
MONROE HEALTH CENTER-PETERSTOWN LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER BRADY (CEO)
(304) 772-3064
Entity
Organization
Contact information
Practice address
591 US HIGHWAY 219, PETERSTOWN, WV 24963
(304) 753-4336
(304) 753-4097
Mailing address
200 HEALTH CENTER DRIVE, UNION, WV 24983
(304) 772-3064
(304) 772-3296
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810001366
—
WV
Enumeration date
04/18/2007
Last updated
08/22/2020
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