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General NPI Number Information
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NPI Number | 1194776823
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Entity Type | Organization
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Legal Business Name | BRAXTON VA CLINIC
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 707 ELK ST
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City | GASSAWAY
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State | WV
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Zip | 26624-1113
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Country | US
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Telephone | 304-364-8941
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Fax | 304-364-8943
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Provider Business Mailing Address
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Address Line | 707 ELK ST
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City | GASSAWAY
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State | WV
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Zip | 26624-1113
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Country | US
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Telephone | 304-364-8941
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Fax | 304-364-8943
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Authorized Official
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Title or Position | DIRECTOR, BUSINESS DEVELOPMENT
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Name | BARBARA MAYERICK
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Credential |
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Telephone | 202-254-0339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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