Healthcare Provider Details

I. General information

NPI: 1710098462
Provider Name (Legal Business Name): MEDPOINTE OF HARRISON COUNTY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 EMILY DR
CLARKSBURG WV
26301-5512
US

IV. Provider business mailing address

469 EMILY DR
CLARKSBURG WV
26301-5512
US

V. Phone/Fax

Practice location:
  • Phone: 304-423-5180
  • Fax: 304-423-5185
Mailing address:
  • Phone: 304-423-5180
  • Fax: 304-423-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL T MONTGOMERY
Title or Position: PARTNER
Credential: D.O.
Phone: 304-423-5180