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General NPI Number Information
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NPI Number | 1821049776
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Entity Type | Organization
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Legal Business Name | EDEN FAMILY PRACTICE INC.
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 313 HUDGINS ST SUITE 200
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City | LOGAN
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State | WV
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Zip | 25601-3535
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Country | US
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Telephone | 304-752-9450
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Fax |
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Provider Business Mailing Address
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Address Line | 3306 BRIDGET DR
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City | COLUMBUS
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State | OH
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Zip | 43221-4431
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Country | US
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Telephone | 614-876-9233
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MRS. PATTY RADCLIFFE
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Credential |
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Telephone | 614-876-9233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1939
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License Number State | WV
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