Healthcare Provider Details

I. General information

NPI: 1235489931
Provider Name (Legal Business Name): SPRING MILLS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 T J JACKSON DR
FALLING WATERS WV
25419-4698
US

IV. Provider business mailing address

PO BOX 780
MORGANTOWN WV
26507-0780
US

V. Phone/Fax

Practice location:
  • Phone: 304-820-1031
  • Fax: 304-820-1033
Mailing address:
  • Phone: 304-285-7100
  • Fax: 304-293-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREA RUMBLE
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 304-285-7101