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General NPI Number Information
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NPI Number | 1891756029
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Entity Type | Organization
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Legal Business Name | GRAND CENTRAL FAMILY MEDICINE, P.L.L.C.
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 418 GRAND PK DR SUITE 312
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City | PARKERSBURG
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State | WV
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Zip | 26101-0000
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Country | US
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Telephone | 304-422-3400
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Fax | 304-422-7893
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Provider Business Mailing Address
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Address Line | 418 GRAND PK DR SUITE 312
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City | PARKERSBURG
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State | WV
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Zip | 26101-0000
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Country | US
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Telephone | 304-422-3400
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Fax | 304-422-7893
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Authorized Official
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Title or Position | OWNER
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Name | DAVID W AVERY
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Credential | M.D.
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Telephone | 304-422-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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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