Organization
SOUTH CHARLESTON PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE BETH RAY (OFFICE MANAGER)
(304) 766-4469
Entity
Organization
Contact information
Practice address
4607 MACCORKLE AVE SW, STE 400, CHARLESTON, WV 25309-1364
(304) 766-4400
(304) 766-4417
Mailing address
4607 MACCORKLE AVE SW, STE 400, CHARLESTON, WV 25309-1364
(304) 766-4400
(304) 766-4417
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6705182000
—
WV
Enumeration date
12/13/2006
Last updated
08/22/2020
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