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General NPI Number Information
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NPI Number | 1891176137
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Entity Type | Organization
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Legal Business Name | ST GEORGE MEDICAL CLINIC INC
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 81 TUCKER VALLEY SCHOOL RD
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City | HAMBLETON
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State | WV
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Zip | 26269-8052
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Country | US
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Telephone | 304-478-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 6420 HOLLY MEADOWS RD
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City | PARSONS
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State | WV
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Zip | 26287-8055
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Country | US
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Telephone | 304-478-3339
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Fax | 304-478-3311
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PAUL H WAMSLEY JR.
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Credential |
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Telephone | 304-478-3339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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