Organization
TEAYS VALLEY FAMILY MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES BUKOVINSKY MD (PRESIDENT OWNER)
(304) 562-8505
Entity
Organization
Contact information
Practice address
3520 TEAYS VALLEY RD, SUITE 1, HURRICANE, WV 25526-9479
(304) 562-8505
(304) 562-8507
Mailing address
3520 TEAYS VALLEY RD, SUITE #1, HURRICANE, WV 25526-9479
(304) 562-8505
(304) 562-8507
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001710576
BLUE CROSS BLUE SHIELD
WV
05
—
0042568000
—
WV
Enumeration date
11/30/2005
Last updated
04/25/2008
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