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General NPI Number Information
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NPI Number | 1952116550
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Entity Type | Organization
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Legal Business Name | WILDERNESS ROAD HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 19 MEDICAL LOOP STE 4
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City | WHITLEY CITY
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State | KY
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Zip | 42653-4382
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Country | US
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Telephone | 606-376-2639
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Fax |
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Provider Business Mailing Address
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Address Line | 19 MEDICAL LOOP STE 4
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City | WHITLEY CITY
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State | KY
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Zip | 42653-4382
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Country | US
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Telephone | 606-376-2639
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. ERIC ROBERT WEBER
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Credential | MD
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Telephone | 606-376-2639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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