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General NPI Number Information
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NPI Number | 1134151228
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Entity Type | Organization
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Legal Business Name | HILSBOS FAMILY CARE, PLLC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 5 ERWIN LN STE B
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City | FAIRMONT
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State | WV
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Zip | 26554-1376
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Country | US
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Telephone | 304-612-9186
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Fax | 304-366-7763
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Provider Business Mailing Address
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Address Line | 5 ERWIN LN STE B
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City | FAIRMONT
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State | WV
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Zip | 26554-1376
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Country | US
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Telephone | 304-612-9186
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Fax | 304-366-7763
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. KENNETH HILSBOS
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Credential | M.D.
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Telephone | 304-366-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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