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General NPI Number Information
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NPI Number | 1558846261
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Entity Type | Organization
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Legal Business Name | THE CARSON BLACK LUNG RESEARCH AND EDUCATION CENTER
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 40518 W MORGAN AVE
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City | PENNINGTON GAP
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State | VA
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Zip | 24277-1822
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Country | US
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Telephone | 252-452-6075
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Fax | 276-318-0298
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Provider Business Mailing Address
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Address Line | 850 RIVERVIEW AVE FL 3
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City | PINEVILLE
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State | KY
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Zip | 40977-1452
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Country | US
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Telephone | 252-452-4080
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Fax | 276-318-0298
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. RODNEY TERRY
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Credential |
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Telephone | 252-452-6075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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