Healthcare Provider Details

I. General information

NPI: 1215107446
Provider Name (Legal Business Name): PUTNAM COUNTY SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 COURTHOUSE DR
WINFIELD WV
25213-9347
US

IV. Provider business mailing address

501 22ND ST
DUNBAR WV
25064-1711
US

V. Phone/Fax

Practice location:
  • Phone: 304-586-0500
  • Fax: 304-586-0553
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateWV

VIII. Authorized Official

Name: DONNA MILLER
Title or Position: MEDICAID SPECIALIST
Credential:
Phone: 304-766-7655