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General NPI Number Information
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NPI Number | 1093183774
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Entity Type | Organization
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Legal Business Name | MINERAL COUNTY BOARD OF HEALTH
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | RR 3 BOX 3045
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City | KEYSER
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State | WV
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Zip | 26726-9401
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Country | US
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Telephone | 130-478-8132
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Fax | 130-478-8602
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Provider Business Mailing Address
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Address Line | RR 3 BOX 3045
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City | KEYSER
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State | WV
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Zip | 26726-9401
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Country | US
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Telephone | 130-478-8132
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Fax | 130-478-8602
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ANDREW J ROOT
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Credential | R.S.
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Telephone | 130-478-8132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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