Organization
CLENDENIN HEALTH CENTER LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RUSSELL (ADMINISTRATIVE ASSISTANT)
(304) 734-2040
Entity
Organization
Contact information
Practice address
107 KOONTZ AVE STE 200, CLENDENIN, WV 25045-9581
(304) 734-2040
(301) 734-2047
Mailing address
PO BOX 70, DAWES, WV 25054-0070
(304) 734-2040
(304) 734-2047
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
09/26/2014
Last updated
07/30/2025
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