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General NPI Number Information
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NPI Number | 1699840405
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH FOUNDATION LOGAN
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | HC 68 BOX 1000 SUITE 3
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City | LOGAN
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State | WV
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Zip | 25601-9620
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Country | US
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Telephone | 304-239-3888
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Fax | 304-239-3811
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Provider Business Mailing Address
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Address Line | HC 68 BOX 1000 SUITE 3
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City | LOGAN
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State | WV
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Zip | 25601-9620
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Country | US
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Telephone | 304-239-3888
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Fax | 304-239-3811
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT ROSCOE MAYS III
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Credential |
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Telephone | 304-583-6541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291900000X
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Taxonomy Name | Military Clinical Medical Laboratory
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License Number |
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License Number State | WV
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