Healthcare Provider Details

I. General information

NPI: 1083702336
Provider Name (Legal Business Name): TOTAL FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 MORGANTOWN STREET
KINGWOOD WV
26537
US

IV. Provider business mailing address

428 MORGANTOWN STREET
KINGWOOD WV
26537
US

V. Phone/Fax

Practice location:
  • Phone: 304-329-0256
  • Fax: 304-329-0733
Mailing address:
  • Phone: 304-329-0256
  • Fax: 304-329-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20093
License Number StateWV

VIII. Authorized Official

Name: RAM M SHETTY
Title or Position: OWNER/MEMBER
Credential: M.D.
Phone: 304-329-0256