Healthcare Provider Details

I. General information

NPI: 1487973756
Provider Name (Legal Business Name): CHARLES E. PORTERFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 3RD ST.
MULLENS WV
25882
US

IV. Provider business mailing address

PO BOX 1307
BECKLEY WV
25802-1307
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-5710
  • Fax: 304-255-5702
Mailing address:
  • Phone: 304-255-5710
  • Fax: 304-255-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES EDWIN PORTERFIELD
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 304-255-5710