Healthcare Provider Details

I. General information

NPI: 1386623783
Provider Name (Legal Business Name): NEW CENTURY MEDICAL OBSERVATION SERVICES OF WEST VIRGINIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4170
  • Fax:
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM A COLE JR.
Title or Position: CEO
Credential: MD
Phone: 800-875-0136