Healthcare Provider Details

I. General information

NPI: 1902580780
Provider Name (Legal Business Name): SPRADLING MEDICAL & TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 TEAYS VALLEY RD
HURRICANE WV
25526-9054
US

IV. Provider business mailing address

3536 TEAYS VALLEY RD
HURRICANE WV
25526-9054
US

V. Phone/Fax

Practice location:
  • Phone: 304-962-1008
  • Fax:
Mailing address:
  • Phone: 304-962-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA SPRADLING
Title or Position: FNP/ MEDICAL DIRECTOR
Credential:
Phone: 304-962-1008