Healthcare Provider Details

I. General information

NPI: 1770856882
Provider Name (Legal Business Name): FORT ASHBY BUSINESS ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 NORTH FORK HIGHWAY
PETERSBURG WV
26847
US

IV. Provider business mailing address

PO BOX 1170
FORT ASHBY WV
26719-1170
US

V. Phone/Fax

Practice location:
  • Phone: 304-298-4404
  • Fax:
Mailing address:
  • Phone: 304-298-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number645
License Number StateWV

VIII. Authorized Official

Name: MR. MELVIN KEITH NESTER SR.
Title or Position: OWNER/OPERATOR
Credential: NBC-HIS
Phone: 304-298-4404