Healthcare Provider Details

I. General information

NPI: 1952416265
Provider Name (Legal Business Name): HUNTINGTON PEDIATRIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 10TH AVE STE 313
HUNTINGTON WV
25701-3554
US

IV. Provider business mailing address

1448 10TH AVE STE 313
HUNTINGTON WV
25701-3554
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-3055
  • Fax:
Mailing address:
  • Phone: 304-522-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI R COSTER
Title or Position: DIRECTOR
Credential:
Phone: 304-522-3055