Healthcare Provider Details

I. General information

NPI: 1376967471
Provider Name (Legal Business Name): CAMC URGENT CARE SOUTHRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RHL STE 3
SOUTH CHARLESTON WV
25309-8275
US

IV. Provider business mailing address

301 RHL STE 3
SOUTH CHARLESTON WV
25309-8275
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7010
  • Fax: 304-388-7015
Mailing address:
  • Phone: 304-388-7010
  • Fax: 304-388-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20
License Number StateWV

VIII. Authorized Official

Name: MR. STEPHEN Z BELL
Title or Position: VP OF FINANCE
Credential:
Phone: 304-388-6251