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General NPI Number Information
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NPI Number | 1962178269
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Entity Type | Organization
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Legal Business Name | VERSACARE MD, LLC
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 1260A GREENBRIER ST
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City | CHARLESTON
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State | WV
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Zip | 25311-1002
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Country | US
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Telephone | 304-915-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 115 TROTTERS LN
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City | CHARLESTON
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State | WV
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Zip | 25312-6770
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | AMANDA E MCCARTY
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Credential | MS, MBA, MHA
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Telephone | 304-615-9925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) 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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