Organization
FAIRMONT MEDICAL GROUP, INC.
Active
Parent organization
FAIRMONT MEDICAL GROUP, INC.
Other names
SHINNSTON CLINICAL LAB
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAIRMONT MEDICAL GROUP, INC.
Authorized official
MS. NANCY L. VANDERGRIFT (PRESIDENT)
(304) 367-8740
Entity
Organization
Contact information
Practice address
1 COLUMBIA RD, SHINNSTON, WV 26431-1016
(304) 367-8710
(304) 366-8529
Mailing address
PO BOX 1112, FAIRMONT, WV 26555-1112
(304) 367-8710
(304) 366-9529
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51D0236497
CLIA #
WV
Enumeration date
12/17/2008
Last updated
12/17/2008
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