Organization
SUMMERSVILLE MULTI- CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIRAFLOR G KHORSHAD M.D. (MEDICAL DIRECTOR)
(304) 872-5500
Entity
Organization
Contact information
Practice address
415 MAIN ST, SUMMERSVILLE, WV 26651-1343
(304) 872-5500
(304) 872-5592
Mailing address
415 MAIN ST, SUMMERSVILLE, WV 26651-1343
(304) 872-5500
(304) 872-5592
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13212
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006987000
—
WV
01
—
51DO236900
CLIA
WV
Enumeration date
01/16/2008
Last updated
01/16/2008
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