Organization
PREMIER MEDICAL GROUP, INC.
Active
Other names
Premier Medical Group Lab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD STACKPOLE (CFO)
(304) 623-1330
Entity
Organization
Contact information
Practice address
200 ROUTE 98 W ST, STE 103, NUTTER FORT, WV 26301-4385
(304) 623-1330
(304) 623-1333
Mailing address
PO BOX 1610, CLARKSBURG, WV 26302-1610
(304) 623-1330
(304) 623-1333
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0038573000
—
WV
Enumeration date
02/22/2008
Last updated
04/20/2008
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