Healthcare Provider Details

I. General information

NPI: 1669898698
Provider Name (Legal Business Name): FCI BECKLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 INDUSTRIAL PARK ROAD
BEAVER WV
25813
US

IV. Provider business mailing address

PO BOX 1280
BEAVER WV
25813-1280
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-9758
  • Fax: 304-256-4987
Mailing address:
  • Phone: 304-252-9758
  • Fax: 304-256-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DOMINICK H MCLAIN
Title or Position: CLINICAL DIRECTOR
Credential: D.O.
Phone: 304-252-9758