Healthcare Provider Details

I. General information

NPI: 1235421983
Provider Name (Legal Business Name): PHYSICIAN'S FIRST CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROUTE 98 W ST SUITE 103
NUTTER FORT WV
26301-4385
US

IV. Provider business mailing address

200 ROUTE 98 W ST SUITE 103
NUTTER FORT WV
26301-4385
US

V. Phone/Fax

Practice location:
  • Phone: 304-326-0092
  • Fax: 304-623-1073
Mailing address:
  • Phone: 304-326-0092
  • Fax: 304-623-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21580W
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21580W
License Number StateWV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELLE WHITE
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-326-0092