MEDICARE: KANAWHA VALLEY INTERNAL MEDICINE PLLC

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
1	207R00000X	Internal Medicine Physician	1872	WV

General Provider Information

NPI Number	:	1659574382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANAWHA VALLEY INTERNAL MEDICINE PLLC

Provider Business Mailing Address
First Line	:	15 QUAIL POINTE DR
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-4570
Country	:	US
Telephone Number	:	304-345-3228
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 STAUNTON AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1327
Country	:	US
Telephone Number	:	304-720-3600
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. KIMBERLY SPURLOCK
Credential	:	D.O.
Telephone Number	:	304-720-3600

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	08/22/2020

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