Healthcare Provider Details

I. General information

NPI: 1598756207
Provider Name (Legal Business Name): WYTHVILLE MANAGEMENT CONSULTANTS LLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SENECA TRL STE 8 GREENBRIER VALLEY MALL
LEWISBURG WV
24901-1579
US

IV. Provider business mailing address

PO BOX 787
CRAB ORCHARD WV
25827-0787
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-3434
  • Fax: 304-647-9789
Mailing address:
  • Phone: 304-253-5793
  • Fax: 304-253-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM M MATTHEWS
Title or Position: MANAGER
Credential:
Phone: 304-253-5793