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General NPI Number Information
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NPI Number | 1548450174
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Entity Type | Organization
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Legal Business Name | APPALACHIAN FAMILY MEDICINE LAB
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 104 STATION PLACE WAY
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City | HURRICANE
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State | WV
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Zip | 25526-8747
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Country | US
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Telephone | 304-757-7788
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Fax | 304-201-1140
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Provider Business Mailing Address
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Address Line | 104 STATION PLACE WAY
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City | HURRICANE
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State | WV
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Zip | 25526-8747
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Country | US
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Telephone | 304-757-7788
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Fax | 304-201-1140
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Authorized Official
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Title or Position | OWNER
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Name | SEAN C DICRISTOFARO
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Credential | MD
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Telephone | 304-757-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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