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General NPI Number Information
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NPI Number | 1710513361
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Entity Type | Organization
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Legal Business Name | JOSHUA E PARKER
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 3014 CHAMPION DR
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-9343
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Country | US
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Telephone | 740-479-0067
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Fax | 304-900-0067
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Provider Business Mailing Address
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Address Line | 2984 COUNTY ROAD 1
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City | SOUTH POINT
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State | OH
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Zip | 45680-8832
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Country | US
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Telephone | 740-479-0067
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA PARKER
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Credential | LPN
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Telephone | 740-479-0067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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