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General NPI Number Information
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NPI Number | 1730897836
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF WEST VIRGINIA MEDICAL, MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 4600 HOUSTON RD BLDG 1
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City | FLORENCE
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State | KY
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Zip | 41042-4820
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Country | US
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Telephone | 859-283-3613
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 MARYLAND WAY STE 120
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City | BRENTWOOD
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State | TN
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Zip | 37027-4993
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LEGAL COUNSEL
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Name | WILLIAM WRIGHT
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Credential |
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Telephone | 615-577-5893
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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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