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General NPI Number Information
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NPI Number | 1275346223
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Entity Type | Organization
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Legal Business Name | PAI MEDICAL WV PLLC
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 3058C CHARLES TOWN RD
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City | KEARNEYSVILLE
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State | WV
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Zip | 25430-2669
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Country | US
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Telephone | 860-322-6712
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Fax | 860-706-8151
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Provider Business Mailing Address
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Address Line | 101 CENTERPOINT DR STE 105
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City | MIDDLETOWN
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State | CT
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Zip | 06457-7568
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Country | US
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Telephone |
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Fax | 860-706-8151
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Authorized Official
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Title or Position | DIRECTOR OF CONTRACTING & CREDENTIA
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Name | MELISSA KING
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Credential |
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Telephone | 860-322-6712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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