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General NPI Number Information
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NPI Number | 1215332465
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Entity Type | Individual
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Provider Name | CHARLES STEVENSON HCP
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Gender | Male
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 3140 ROBERT C BYRD DR
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City | BECKLEY
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State | WV
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Zip | 25801-3723
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Country | US
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Telephone | 304-255-3113
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Fax | 513-332-9042
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Provider Business Mailing Address
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Address Line | 3140 ROBERT C BYRD DR
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City | BECKLEY
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State | WV
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Zip | 25801-3723
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Country | US
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Telephone | 304-255-3113
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Fax | 513-332-9042
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 122370
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License Number State | KY
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