Healthcare Provider Details

I. General information

NPI: 1336113109
Provider Name (Legal Business Name): DRS RW & JA LOVE MEMORIAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 KUYKENDALL LN
MOOREFIELD WV
26836-1167
US

IV. Provider business mailing address

112 KUYKENDALL LANE
MOOREFIELD WV
26836
US

V. Phone/Fax

Practice location:
  • Phone: 304-530-7755
  • Fax: 304-530-7756
Mailing address:
  • Phone: 304-530-7755
  • Fax: 304-530-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BARBARA ANN HARPER
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-530-7755