Organization
WV FAMILY MEDICINE,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KARUNASREE KANURI M.D. (PRESIDENT)
(304) 831-0085
Entity
Organization
Contact information
Practice address
1115 2ND AVE, WEST LOGAN, WV 25601-3309
(304) 831-0085
(304) 831-0088
Mailing address
1115 2ND AVE, WEST LOGAN, WV 25601-3309
(304) 831-0085
(304) 831-0088
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
22060
WV
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810003597
—
WV
Enumeration date
04/18/2007
Last updated
08/22/2020
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