Organization
CLINIC IV INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP HURST RPH (VICE PRESIDENT)
(304) 425-9592
Entity
Organization
Contact information
Practice address
100 NEW HOPE RD, PRINCETON, WV 24740-2143
(304) 425-9592
(304) 487-8967
Mailing address
100 NEW HOPE RD, PRINCETON, WV 24740-2143
(304) 425-9592
(304) 487-8967
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
SP0552254
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0144276001
—
WV
Enumeration date
12/28/2006
Last updated
08/22/2020
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