Healthcare Provider Details

I. General information

NPI: 1346420148
Provider Name (Legal Business Name): FAMILY CARE ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 MORGANTOWN AVE
FAIRMONT WV
26554-4355
US

IV. Provider business mailing address

1031 MORGANTOWN AVE
FAIRMONT WV
26554-4355
US

V. Phone/Fax

Practice location:
  • Phone: 304-363-7940
  • Fax: 304-368-2440
Mailing address:
  • Phone: 304-363-7940
  • Fax: 304-368-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number13530
License Number StateWV

VIII. Authorized Official

Name: DR. PHILIP HENRY HORNER
Title or Position: OWNER
Credential: MD
Phone: 304-363-7940