Organization
FAYETTE CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DARLENE NEWELL RN (OFFICE MANAGER)
(304) 469-3334
Entity
Organization
Contact information
Practice address
1 PHYSICIANS PLAZA, LOCHGELLY, WV 25866
(304) 469-3334
Mailing address
1 PHYSICIANS PLAZA, PO BOX 130, LOCHGELLY, WV 25866
(304) 469-3334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
WV
363L00000X
Nurse Practitioner
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001708474
BC/BS
WV
05
—
0206041000
—
WV
05
—
0206041003
—
WV
01
—
200164
FEDERAL BLACK LUNG
WV
01
—
513906
RURAL HEALTH PROVIDER #
WV
Enumeration date
10/19/2007
Last updated
06/05/2008
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