Organization
WVUPC KANAWHA VALLEY FP (PAASGRP)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY MILLER (PROVIDER RELATIONS ANALYST)
(304) 293-5033
Entity
Organization
Contact information
Practice address
401 DIVISION STREET, SUITE 205, SOUTH CHARLESTON, WV 25309-0000
(304) 293-5033
(304) 293-6963
Mailing address
PO BOX 7000, MORGANTOWN, WV 26507-7000
(304) 293-5033
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
67050360001
WV
Other
Enumeration date
05/21/2007
Last updated
08/22/2020
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