| Wvupc Kanawha Valley Fp (paasgrp) | |
|
401 Division Street Suite 205 South Charleston WV 25309-0000 | |
| (304) 293-5033 | |
| (304) 293-6963 |
| Full Name | Wvupc Kanawha Valley Fp (paasgrp) |
|---|---|
| Speciality | Family Medicine |
| Location | 401 Division Street, South Charleston, West Virginia |
| Authorized Official Name and Position | Terry Miller (PROVIDER RELATIONS ANALYST) |
| Authorized Official Contact | 3042935033 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wvupc Kanawha Valley Fp (paasgrp) Po Box 7000 Morgantown WV 26507-7000 Ph: (304) 293-5033 | Wvupc Kanawha Valley Fp (paasgrp) 401 Division Street Suite 205 South Charleston WV 25309-0000 Ph: (304) 293-5033 |
| NPI Number | 1902014038 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902014038 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 67050360001 (West Virginia) | Primary |
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