Organization
HUNTINGTON PEDIATRIC CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI R COSTER (DIRECTOR)
(304) 522-3055
Entity
Organization
Contact information
Practice address
1448 10TH AVE STE 313, HUNTINGTON, WV 25701-3554
(304) 522-3055
Mailing address
1448 10TH AVE STE 313, HUNTINGTON, WV 25701-3554
(304) 522-3055
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017380002
—
WV
05
—
0668737
—
OH
05
—
1802119000
—
WV
05
—
4000477000
—
WV
Enumeration date
08/20/2006
Last updated
08/22/2020
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