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General NPI Number Information
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NPI Number | 1659574382
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Entity Type | Organization
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Legal Business Name | KANAWHA VALLEY INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3418 STAUNTON AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1327
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Country | US
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Telephone | 304-720-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 15 QUAIL POINTE DR
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City | CHARLESTON
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State | WV
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Zip | 25302-4570
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Country | US
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Telephone | 304-345-3228
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KIMBERLY SPURLOCK
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Credential | D.O.
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Telephone | 304-720-3600
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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 | 1872
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License Number State | WV
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