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General NPI Number Information
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NPI Number | 1285782037
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 1315 MOUNT DE CHANTAL RD
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City | WHEELING
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State | WV
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Zip | 26003-6357
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Country | US
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Telephone | 304-243-7117
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Fax | 304-243-5470
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Provider Business Mailing Address
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Address Line | 1315 MOUNT DE CHANTAL RD
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City | WHEELING
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State | WV
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Zip | 26003-6357
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Country | US
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Telephone | 304-243-7117
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Fax | 304-243-5470
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JANE LUCEY
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Credential |
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Telephone | 304-243-7117
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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 | WV1899, WV1898
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License Number State | WV
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