Healthcare Provider Details

I. General information

NPI: 1215648548
Provider Name (Legal Business Name): HEALTH ADMIX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 RURAL ACRES DR
BECKLEY WV
25801-3579
US

IV. Provider business mailing address

119 RURAL ACRES DR
BECKLEY WV
25801-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-237-5051
  • Fax:
Mailing address:
  • Phone: 304-237-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER MARTIN
Title or Position: CO-OWNER
Credential:
Phone: 304-237-5051