Organization
COAL COUNTRY CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL MERRITT KOSTENKO D.O. (PRESIDENT)
(304) 763-0199
Entity
Organization
Contact information
Practice address
3050 C AND O DAM RD, DANIELS, WV 25832-9718
(304) 763-0199
(304) 763-2137
Mailing address
PO BOX 88, DANIELS, WV 25832-0088
(304) 763-0199
(304) 763-2137
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
1078
WV
Other
Enumeration date
11/13/2007
Last updated
11/13/2007
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