Healthcare Provider Details

I. General information

NPI: 1902477714
Provider Name (Legal Business Name): WATERFRONT URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DON KNOTTS BLVD
MORGANTOWN WV
26501-0113
US

IV. Provider business mailing address

515 GRAND ST
MORGANTOWN WV
26501-6607
US

V. Phone/Fax

Practice location:
  • Phone: 304-290-0000
  • Fax:
Mailing address:
  • Phone: 304-290-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN BLANKENSHIP
Title or Position: MEMBER
Credential: MD
Phone: 304-290-0000