Healthcare Provider Details

I. General information

NPI: 1992923734
Provider Name (Legal Business Name): CENTER FOR ALTERNATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300B PRESTIGE PARK DR
HURRICANE WV
25526-8419
US

IV. Provider business mailing address

300B PRESTIGE PARK DR
HURRICANE WV
25526-8419
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-3368
  • Fax: 304-757-2402
Mailing address:
  • Phone: 304-757-3368
  • Fax: 304-757-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10463012
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10463012
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10463012
License Number StateWV

VIII. Authorized Official

Name: DR. JOHN PATRICK MACCALLUM
Title or Position: PHYSICIAN
Credential: MD
Phone: 304-757-3368