Healthcare Provider Details

I. General information

NPI: 1497950067
Provider Name (Legal Business Name): ASSOCIATES FOR WOMEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 E MAIN ST
BUCKHANNON WV
26201-2754
US

IV. Provider business mailing address

56 E MAIN ST
BUCKHANNON WV
26201-2754
US

V. Phone/Fax

Practice location:
  • Phone: 304-472-7473
  • Fax: 304-472-0533
Mailing address:
  • Phone: 304-472-7473
  • Fax: 304-472-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number037856
License Number StateWV

VIII. Authorized Official

Name: DR. KIMBERLY M FARRY
Title or Position: OWNER
Credential: M.D.
Phone: 304-472-7473