Healthcare Provider Details

I. General information

NPI: 1114862240
Provider Name (Legal Business Name): FAYETTE PHYICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PRESTON ST
RANSON WV
25438-1631
US

IV. Provider business mailing address

PO BOX 796
MORGANTOWN WV
26507-0796
US

V. Phone/Fax

Practice location:
  • Phone: 304-728-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES JONES
Title or Position: AVP OF FINANCE
Credential:
Phone: 304-282-1611