Healthcare Provider Details

I. General information

NPI: 1275095580
Provider Name (Legal Business Name): OHIO VALLEY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 NORTH MINE ST
MCCORMICK SC
29835
US

IV. Provider business mailing address

PO BOX 390
HUNTINGTON WV
25708-0390
US

V. Phone/Fax

Practice location:
  • Phone: 864-852-3306
  • Fax:
Mailing address:
  • Phone: 864-366-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TARA LANDERS
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 304-429-1088