Healthcare Provider Details

I. General information

NPI: 1336148931
Provider Name (Legal Business Name): OAK HILL CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 JONES AVE
OAK HILL WV
25901-2909
US

IV. Provider business mailing address

PO BOX 848409
BOSTON MA
02284-8409
US

V. Phone/Fax

Practice location:
  • Phone: 304-469-2500
  • Fax:
Mailing address:
  • Phone: 877-848-1457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateWV

VIII. Authorized Official

Name: DEBBIE BREWER
Title or Position: DIRECTOR OF PROVIDER ENROLLMENT
Credential:
Phone: 877-892-9813