Healthcare Provider Details

I. General information

NPI: 1912667387
Provider Name (Legal Business Name): FERRELL PHYSICIAN SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 FORTRESS BLVD
MORGANTOWN WV
26508-1351
US

IV. Provider business mailing address

1001 CONSOL ENERGY DR
CANONSBURG PA
15317-6506
US

V. Phone/Fax

Practice location:
  • Phone: 844-852-9510
  • Fax: 888-241-5699
Mailing address:
  • Phone: 304-225-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRETT GALL
Title or Position: DIRECTOR PAYOR CONTRACTING
Credential:
Phone: 304-225-2500