Organization
WEST VIRGINIA UNIVERSITY MEDICAL CORPORATION
Active
Other names
WVU Obstetrics & Gynecology-Bridgeport
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY D MILLER (PROVIDER ENROLLMENT SPECIALIST)
(304) 285-7101
Entity
Organization
Contact information
Practice address
527 MEDICAL PARK DR, SUITE 108, BRIDGEPORT, WV 26330-9008
(304) 848-2152
Mailing address
P O BOX 780, MORGANTOWN, WV 26507-0780
(304) 285-7101
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
51D2012387
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011526000
—
WV
Enumeration date
10/30/2012
Last updated
10/30/2012
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