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General NPI Number Information
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NPI Number | 1710231170
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Entity Type | Organization
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Legal Business Name | WVU URGENT CARE LAB
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 203 EAST FOURTH AVENUE SUITE B
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City | RANSON
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State | WV
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Zip | 25438
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Country | US
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Telephone | 304-725-2273
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Fax | 304-725-9843
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Provider Business Mailing Address
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Address Line | PO BOX 780
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City | MORGANTOWN
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State | WV
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Zip | 26507-0780
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Country | US
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Telephone | 304-285-7100
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Fax | 304-285-7126
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | ANDREA RUMBLE
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Credential |
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Telephone | 304-285-7101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 51D2047840
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License Number State | WV
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