Healthcare Provider Details

I. General information

NPI: 1700899226
Provider Name (Legal Business Name): CAMC URGENT CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GOFF MOUNTAIN RD SUITE 3
CROSS LANES WV
25313-1415
US

IV. Provider business mailing address

314 GOFF MOUNTAIN ROAD, SUITE 3
CROSS LANES WV
25313-1415
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7070
  • Fax:
Mailing address:
  • Phone: 304-388-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number14012
License Number StateWV

VIII. Authorized Official

Name: JEFF GOODE
Title or Position: ADMINISTRATOR
Credential:
Phone: 304-388-7784