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General NPI Number Information
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NPI Number | 1871539296
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Entity Type | Organization
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Legal Business Name | WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE CLINIC INC D/B/A ROBERT C. BYRD CLINIC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 1464 JEFFERSON ST N
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City | LEWISBURG
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State | WV
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Zip | 24901-1380
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Country | US
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Telephone | 304-645-3220
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Fax | 304-645-4103
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Provider Business Mailing Address
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Address Line | 1464 JEFFERSON ST N
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City | LEWISBURG
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State | WV
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Zip | 24901-1380
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Country | US
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Telephone | 304-645-3220
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Fax | 304-645-4103
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARY P NEMCIK
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Credential |
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Telephone | 304-645-3220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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