Organization
WV ASTHMA AND ALLERGY CENTERS, INC.
Active
Other names
Asthma and Allergy Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM A MATHENA (ADMINISTRATOR)
(304) 343-4300
Entity
Organization
Contact information
Practice address
401 6TH AVE, SUITE 303D, MONTGOMERY, WV 25136-2116
(304) 343-4300
(304) 343-5473
Mailing address
208 MACCORKLE AVE SE, CHARLESTON, WV 25314-1160
(304) 343-4300
(304) 343-5473
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
78687
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006123000
—
WV
Enumeration date
10/04/2012
Last updated
10/04/2012
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