Healthcare Provider Details

I. General information

NPI: 1992826176
Provider Name (Legal Business Name): WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 JEFFERSON ST N
LEWISBURG WV
24901-1380
US

IV. Provider business mailing address

400 NORTH JEFFERSON STREET
LEWISBURG WV
24901
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-3220
  • Fax: 304-793-2491
Mailing address:
  • Phone: 304-645-3220
  • Fax: 304-645-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JILL MCCLUNG
Title or Position: DIR OF BUSINESS OPERATIONS
Credential:
Phone: 304-645-3220