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General NPI Number Information
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NPI Number | 1578692679
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Entity Type | Organization
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Legal Business Name | MEDBROOK MEDICAL ASSOC. INC.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1370 JOHNSON AVE
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1382
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Country | US
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Telephone | 304-842-7186
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Fax | 304-842-9005
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Provider Business Mailing Address
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Address Line | 1370 JOHNSON AVE
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1382
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Country | US
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Telephone | 304-842-7186
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Fax | 304-842-9005
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LAURIE SALSER
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Credential |
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Telephone | 304-842-7186
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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 | WV
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