Healthcare Provider Details

I. General information

NPI: 1811074701
Provider Name (Legal Business Name): JARRELL FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1288 B STREET
CEREDO WV
25507-0327
US

IV. Provider business mailing address

1288 B. STREET PO BOX 327
CEREDO WV
25507-0327
US

V. Phone/Fax

Practice location:
  • Phone: 304-453-3334
  • Fax: 304-453-2608
Mailing address:
  • Phone: 304-453-3334
  • Fax: 304-453-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20727
License Number StateWV

VIII. Authorized Official

Name: EUGENIA M JARRELL
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 304-453-3334