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NPI Code Detail

MEDICARE: RUTH A FULL PA-C

MEDICARE: RUTH A FULL PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant750WV

General Provider Information

NPI Number : 1518962232
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH A FULL PA-C
Provider Business Mailing Address
First Line : PO BOX 609
Second Line :
City : ELIZABETH
State : WV
Zip : 26143-0609
Country : US
Telephone Number : 304-275-3301
Fax Number : 304-275-4798
Provider Business Practice Location Address
First Line : 483 COURT ST
Second Line :
City : ELIZABETH
State : WV
Zip : 26143-1109
Country : US
Telephone Number : 304-275-3301
Fax Number : 304-275-4798
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 04/02/2020

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Directions to “ RUTH A FULL PA-C” Practice Location

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