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General NPI Number Information
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NPI Number | 1679944383
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Entity Type | Organization
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Legal Business Name | ONCALL HEALTH AND AESTHETIC CARE
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 08/13/2023
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Provider Practice Location Address
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Address Line | 402 C STREET
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City | CEREDO
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State | WV
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Zip | 25507
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Country | US
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Telephone | 304-908-1204
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Fax | 304-908-1224
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Provider Business Mailing Address
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Address Line | PO BOX 4100
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City | BARBOURSVILLE
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State | WV
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Zip | 25504
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Country | US
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Telephone | 304-955-6200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY S MAYNARD
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Credential | APRN
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Telephone | 304-908-1204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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