Healthcare Provider Details

I. General information

NPI: 1679292445
Provider Name (Legal Business Name): MADISON CLARE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 MAIN ST E
OAK HILL WV
25901-2341
US

IV. Provider business mailing address

432 HIGHLAND AVE
OAK HILL WV
25901-3440
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-0885
  • Fax: 304-465-0886
Mailing address:
  • Phone: 304-894-6648
  • Fax: 304-471-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: