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General NPI Number Information
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NPI Number | 1003072398
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Entity Type | Organization
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Legal Business Name | DR. RICK L HOUDERSHELDT, INC
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 3705 TEAYS VALLEY RD SUITE 202
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City | HURRICANE
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State | WV
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Zip | 25526-8757
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Country | US
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Telephone | 304-757-6990
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Fax | 304-757-0912
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Provider Business Mailing Address
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Address Line | 3705 TEAYS VALLEY RD SUITE 202
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City | HURRICANE
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State | WV
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Zip | 25526-8757
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Country | US
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Telephone | 304-757-6990
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Fax | 304-757-0911
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Authorized Official
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Title or Position | CEO
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Name | DR. RICK L HOUDERSHELDT
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Credential | DO
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Telephone | 304-757-6990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 789
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License Number State | WV
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