Healthcare Provider Details

I. General information

NPI: 1861520462
Provider Name (Legal Business Name): FOREST HILL FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WV RURAL ROUTE 12
FOREST HILL WV
24935-0153
US

IV. Provider business mailing address

PO BOX 153
FOREST HILL WV
24935-0153
US

V. Phone/Fax

Practice location:
  • Phone: 304-466-1152
  • Fax: 304-466-1192
Mailing address:
  • Phone: 304-466-1152
  • Fax: 304-466-1192

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: JAMES HOWARD BLUME
Title or Position: OWNER
Credential: DO
Phone: 304-466-1152