Organization
WV PHS MEDICAL CORPORATION
Active
Parent organization
PROVIDER HEALTH SERVICES LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDER HEALTH SERVICES LLC
Authorized official
NICOLE HOWARD (CFO)
(337) 991-9276
Entity
Organization
Contact information
Practice address
200 ASSOCIATION DR, SUITE 140, CHARLESTON, WV 25311-1278
(901) 261-4858
(901) 261-4867
Mailing address
1509 DULLES DRIVE, LAFAYETTE, LA 70506
(337) 991-9276
(337) 991-9288
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/16/2010
Last updated
07/02/2014
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