Healthcare Provider Details

I. General information

NPI: 1114342243
Provider Name (Legal Business Name): ANCHOR MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LOCKHEED DR
BEAVER WV
25813-8962
US

IV. Provider business mailing address

106 LOCKHEED DR
BEAVER WV
25813-8962
US

V. Phone/Fax

Practice location:
  • Phone: 304-253-5155
  • Fax:
Mailing address:
  • Phone: 304-253-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number51350
License Number StateWV

VIII. Authorized Official

Name: TERESA L TATE
Title or Position: OWNER
Credential: MSN, APRN, FNP-BC
Phone: 304-253-5155