Organization
MERCER COUNTY HEALTH DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PHYLLIS SUSAN KADAR (ADMINISTRATOR)
(304) 324-8367
Entity
Organization
Contact information
Practice address
978 BLUE PRINCE RD, BLUEFIELD, WV 24701-5074
(304) 324-8367
(304) 324-8843
Mailing address
978 BLUE PRINCE RD, BLUEFIELD, WV 24701-5074
(304) 324-8367
(304) 324-8843
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001711297
BLUE CROSS BLUE SHIELD
WV
05
—
0021320000
—
WV
01
—
1540381
UMWA PROVIDER NUMBER
WV
Enumeration date
06/14/2007
Last updated
03/24/2015
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