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General NPI Number Information
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NPI Number | 1619090743
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Entity Type | Organization
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Legal Business Name | BURNSVILLE MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 110 MUNICIPAL STREET
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City | BURNSVILLE
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State | WV
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Zip | 26335-0424
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Country | US
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Telephone | 304-853-2278
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Fax | 304-853-2520
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Provider Business Mailing Address
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Address Line | 110 MUNICIPAL STREET PO BOX 424
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City | BURNSVILLE
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State | WV
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Zip | 26335-0424
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Country | US
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Telephone | 304-853-2278
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Fax | 304-853-2520
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTOINE KATINY
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Credential | MD
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Telephone | 304-853-2278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 17332
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License Number State | WV
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