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General NPI Number Information
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NPI Number | 1649467846
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Entity Type | Organization
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Legal Business Name | POZEGA WELLNESS CENTER INC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 5324 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-2222
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Country | US
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Telephone | 304-925-7001
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Fax | 304-925-7234
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Provider Business Mailing Address
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Address Line | 5324 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-2222
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Country | US
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Telephone | 304-925-7001
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Fax | 304-925-7234
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY C POZEGA
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Credential | DO
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Telephone | 304-925-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 1512
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License Number State | WV
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