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General NPI Number Information
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NPI Number | 1902135130
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Entity Type | Organization
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Legal Business Name | 5 STAR ORIENTAL MEDICINE
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 28 CHURCH STREET
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City | MATHEWS
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State | VA
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Zip | 23109
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Country | US
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Telephone | 804-725-9001
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Fax | 804-725-9005
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Provider Business Mailing Address
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Address Line | PO BOX 1460
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City | MATHEWS
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State | VA
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Zip | 23109-1460
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Country | US
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Telephone | 804-725-9001
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Fax | 804-725-9005
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Authorized Official
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Title or Position | OWNER
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Name | MS. AUDREY L STEWART
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Credential | L.AC.
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Telephone | 804-725-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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