Healthcare Provider Details

I. General information

NPI: 1184288623
Provider Name (Legal Business Name): MSRC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PATRICK STREET PLZ
CHARLESTON WV
25387-2444
US

IV. Provider business mailing address

102 PATRICK STREET PLZ
CHARLESTON WV
25387-2444
US

V. Phone/Fax

Practice location:
  • Phone: 304-223-3200
  • Fax:
Mailing address:
  • Phone: 304-223-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA PRESTON GALBRAITH
Title or Position: OWNER
Credential:
Phone: 304-223-3200