Organization
WVUPC QUARRY MANOR
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
699 S PARK RD, CHARLESTON, WV 25304-2627
(304) 347-1296
(304) 347-1394
Mailing address
PO BOX 7000, MORGANTOWN, WV 26507-7000
(304) 293-7401
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4002106000
—
WV
Enumeration date
02/17/2011
Last updated
02/17/2011
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