Healthcare Provider Details

I. General information

NPI: 1306419734
Provider Name (Legal Business Name): WV MEDICAL SERVICES AND COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 6TH AVE
SAINT ALBANS WV
25177-2838
US

IV. Provider business mailing address

7 ANCHORS WAY
WINFIELD WV
25213-9786
US

V. Phone/Fax

Practice location:
  • Phone: 304-553-5232
  • Fax: 304-729-8024
Mailing address:
  • Phone: 304-553-5232
  • Fax: 304-729-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. CLARA R BLANKENSHIP
Title or Position: OWNER
Credential:
Phone: 304-553-5232