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Organization

WVUPC-CAMC FAM MED SURGERY CENTER

Active
Other names
WVU Physicians of Charleston
Organization subpart
No

Provider details

NPI number
Authorized official
TERRY MILLER (PROVIDER RELATIONS ANALYST)
(304) 293-5033
Entity
Organization

Contact information

Practice address
1201 WASHINGTON ST E, CHARLESTON, WV 25301-1834
(304) 347-1296
Mailing address
PO BOX 7000, MORGANTOWN, WV 26507-7000
(304) 293-7401

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
101
WV BLUE SHIELD SUFFIX
WV
05
400210600
WV
01
51D0865570
CLIA FACILITY LAB NUMBER
WV
01
6705038001
FACILTY EPSDT NUMBER
WV
Enumeration date
02/15/2011
Last updated
02/15/2011
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