Healthcare Provider Details

I. General information

NPI: 1801006200
Provider Name (Legal Business Name): WVVA HEALTH CARE ALLIANCE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 DAVID STUART ROAD
LEWISBURG WV
24901-9463
US

IV. Provider business mailing address

PO BOX 457 200 POCAHONTAS TRAIL
WHITE SULPHUR SPRINGS WV
24986-0457
US

V. Phone/Fax

Practice location:
  • Phone: 304-793-2274
  • Fax: 304-793-2275
Mailing address:
  • Phone: 304-536-5030
  • Fax: 304-536-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER S MCCORD
Title or Position: PRESIDENT CEO
Credential:
Phone: 304-536-5030