Healthcare Provider Details

I. General information

NPI: 1679944383
Provider Name (Legal Business Name): ONCALL HEALTH AND AESTHETIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 C STREET
CEREDO WV
25507
US

IV. Provider business mailing address

PO BOX 4100
BARBOURSVILLE WV
25504
US

V. Phone/Fax

Practice location:
  • Phone: 304-908-1204
  • Fax: 304-908-1224
Mailing address:
  • Phone: 304-955-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY S MAYNARD
Title or Position: OWNER
Credential: APRN
Phone: 304-908-1204