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General NPI Number Information
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NPI Number | 1326796822
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Entity Type | Organization
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Legal Business Name | ST GEORGE MEDICAL CLINIC INC
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 6368 APPALACHIAN HWY
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City | DAVIS
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State | WV
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Zip | 26260
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Country | US
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Telephone | 304-478-3355
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Fax | 304-936-6173
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Provider Business Mailing Address
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Address Line | 8591 HOLLY MEADOWS RD
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City | PARSONS
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State | WV
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Zip | 26287-8604
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Country | US
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Telephone | 304-478-3339
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Fax | 304-478-3311
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PAUL H WAMSLEY
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Credential |
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Telephone | 304-478-3339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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