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General NPI Number Information
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NPI Number | 1730635863
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Entity Type | Organization
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Legal Business Name | WILLOW CREEK HEALTH CLINIC INC
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 15237 COAL HERITAGE ROAD/US-52 NORTH HONEYCAMP /247
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City | RODERFIELD
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State | WV
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Zip | 24881
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Country | US
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Telephone | 304-436-8323
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 219
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City | PREMIER
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State | WV
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Zip | 24878-0219
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Country | US
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Telephone | 304-436-8323
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN PATRICIA ADDAIR
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Credential | M.S.N, F.N.P
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Telephone | 304-436-8323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 42727
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License Number State | WV
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