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General NPI Number Information
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NPI Number | 1033162359
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Entity Type | Organization
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Legal Business Name | NEW CREEK STATION
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | RR 3 BOX 3267
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City | KEYSER
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State | WV
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Zip | 26726-9422
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Country | US
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Telephone | 304-788-6462
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Fax | 304-788-6555
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Provider Business Mailing Address
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Address Line | PO BOX 567
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City | KEYSER
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State | WV
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Zip | 26726-0567
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Country | US
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Telephone | 304-788-6462
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Fax | 304-788-6555
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Authorized Official
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Title or Position | PHYSICIAN/OPERATOR
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Name | DR. CHARLES BESS II
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Credential | M.D.
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Telephone | 304-788-6462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 028240
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License Number State | WV
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