Healthcare Provider Details

I. General information

NPI: 1962876110
Provider Name (Legal Business Name): PRESTON-TAYLOR COMMUNITY HEALTH CENTERS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CORTLAND ACRES LN
THOMAS WV
26292-8066
US

IV. Provider business mailing address

30 CORTLAND ACRES LN
THOMAS WV
26292-8066
US

V. Phone/Fax

Practice location:
  • Phone: 304-463-4200
  • Fax: 304-463-4201
Mailing address:
  • Phone: 304-463-4200
  • Fax: 304-463-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberMP0552420
License Number StateWV

VIII. Authorized Official

Name: KRISTEN WHITE
Title or Position: PIC
Credential:
Phone: 304-463-4200