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General NPI Number Information
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NPI Number | 1962588020
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Entity Type | Organization
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Legal Business Name | CRAIG COUNTY CENTER
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 230 MARKET STREET
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City | NEW CASTLE
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State | VA
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Zip | 24127
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Country | US
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Telephone | 540-864-5556
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Fax | 540-864-5558
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Provider Business Mailing Address
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Address Line | 200 HEALTH CENTER DR.
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City | UNION
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State | WV
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Zip | 24983
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Country | US
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Telephone | 540-864-5556
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Fax | 540-864-5558
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JAMES KILLINGER CORNICK
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Credential | DDS
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Telephone | 540-721-5250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State |
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