Healthcare Provider Details

I. General information

NPI: 1821037102
Provider Name (Legal Business Name): PAMELA MICHELLE ODELL PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 STEVENS RD SENECA HEALTH SERVICES INC
SUMMERSVILLE WV
26651
US

IV. Provider business mailing address

1305 WEBSTER RD SENECA HEALTH SERVICES INC
SUMMERSVILLE WV
26651
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-2659
  • Fax: 304-872-1685
Mailing address:
  • Phone: 304-872-6796
  • Fax: 304-872-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01063
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: