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General NPI Number Information
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NPI Number | 1114009941
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Entity Type | Organization
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Legal Business Name | PRESTON MEMORIAL MEDICAL GROUP
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 500 MARKET STREET GRAFTON CITY HOSPTIAL
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City | GRAFTON
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State | WV
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Zip | 26354
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Country | US
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Telephone | 304-265-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 300 S PRICE ST
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City | KINGWOOD
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State | WV
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Zip | 26537-1442
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Country | US
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Telephone | 304-329-2830
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Fax | 304-791-3737
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Authorized Official
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Title or Position | CEO
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Name | MRS. MELISSA LOCKWOOD
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Credential |
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Telephone | 304-329-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | WV
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