=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255421541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXUS MEDICAL SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2006
-----------------------------------------------------
Last Update Date | 01/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4893 STATE ROUTE 30 SUITE8
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-6494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-600-0607
-----------------------------------------------------
Fax | 724-600-0608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1621 GOFF AVE
-----------------------------------------------------
City | CLARKSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26301-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-875-1942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. FRENCH CARLTON MCCLUNG JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 18008751942
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 029053
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------