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General NPI Number Information
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NPI Number | 1790116341
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Entity Type | Organization
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Legal Business Name | ASSOCIATED SPECIALISTS, INC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 527 MEDICAL PARK DR STE 204
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9009
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Country | US
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Telephone | 304-933-3800
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Fax | 304-933-3815
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Provider Business Mailing Address
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Address Line | 527 MEDICAL PARK DR STE 204
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9009
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Country | US
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Telephone | 304-933-3800
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Fax | 304-933-3815
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. LORI LEE POWELL
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Credential | RHIT
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Telephone | 304-933-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 55-0532650
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License Number State | WV
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