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General NPI Number Information
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NPI Number | 1609299908
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Entity Type | Organization
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Legal Business Name | PRESTON HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 1343 N PRESTON HWY
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City | KINGWOOD
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State | WV
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Zip | 26537-7633
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Country | US
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Telephone | 304-441-2001
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Fax | 304-441-2009
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Provider Business Mailing Address
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Address Line | 1343 N PRESTON HWY
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City | KINGWOOD
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State | WV
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Zip | 26537-7633
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Country | US
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Telephone | 304-441-2001
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Fax | 304-441-2009
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT GOODWIN JR.
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Credential |
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Telephone | 304-441-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number | 2232-1458
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License Number State | WV
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