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General NPI Number Information
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NPI Number | 1770436891
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Entity Type | Organization
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Legal Business Name | FAYETTE PHYSICIAN NETWORK INC
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 100 PIN OAK LN
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City | KEYSER
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State | WV
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Zip | 26726-5908
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Country | US
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Telephone | 304-597-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 796
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City | MORGANTOWN
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State | WV
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Zip | 26507-0796
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Country | US
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Telephone | 724-430-5181
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ACCOUNTING
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Name | JAMES JONES
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Credential |
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Telephone | 304-282-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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