Organization
WVUPC-MEDICINE & SPECIALTY OFFICE
Active
Other names
WVU Physicians of Charleston
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY D MILLER (PROVIDER RELATIONS ANALYST)
(304) 293-5033
Entity
Organization
Contact information
Practice address
4522 MACCORKLE AVE SE, CHARLESTON, WV 25304-1840
(304) 347-1296
(304) 347-1394
Mailing address
PO BOX 7000, MORGANTOWN, WV 26507-7000
(304) 293-7401
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00
WC FACILITY SUFFIX
WV
01
—
121
WV BLUE SHIELD SUFFIX
WV
05
—
4002106000
—
WV
01
—
51D0695014
CLIA FACILITY LAB NUMBER
WV
Enumeration date
02/15/2011
Last updated
02/15/2011
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