Healthcare Provider Details

I. General information

NPI: 1639926181
Provider Name (Legal Business Name): MICHAEL S FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 SUMMERSVILLE LAKE RD
MOUNT NEBO WV
26679-9203
US

IV. Provider business mailing address

PO BOX 569
MOUNT NEBO WV
26679-0569
US

V. Phone/Fax

Practice location:
  • Phone: 304-883-2334
  • Fax:
Mailing address:
  • Phone: 304-883-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: