Organization
CHUA FAMILY PRACTICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE M BROWN RN (OFFICE MANAGER)
(304) 637-0433
Entity
Organization
Contact information
Practice address
1092 HARRISON AVE, ELKINS, WV 26241-3671
(304) 637-0433
(304) 637-0435
Mailing address
PO BOX 490, ELKINS, WV 26241-0490
(304) 637-0433
(304) 637-0435
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
WV1833
WV
207Q00000X
Family Medicine Physician
Primary
WV1965
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810004769
—
WV
01
—
P00012945
RR MEDICARE
WV
01
—
P00118111
RR MEDICARE
WV
Enumeration date
12/14/2006
Last updated
08/22/2020
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