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General NPI Number Information
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NPI Number | 1497030498
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Entity Type | Organization
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Legal Business Name | PEDIATRICS URGENT CARE PLLC
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 128 HEALTH CARE LN
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City | MARTINSBURG
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State | WV
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Zip | 25401-4009
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Country | US
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Telephone | 304-596-2345
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Fax | 304-264-9128
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Provider Business Mailing Address
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Address Line | 128 HEALTH CARE LN
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City | MARTINSBURG
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State | WV
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Zip | 25401-4009
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Country | US
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Telephone | 304-596-2345
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Fax | 304-264-9128
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CAROLINE E JOE
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Credential | M.D.,
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Telephone | 304-596-2345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 2257-1472
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License Number State | WV
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