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NPI Code Detail

MEDICARE: PRINCETON FAMILY MEDICINE, PLLC

MEDICARE: PRINCETON FAMILY MEDICINE, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2005WV

General Provider Information

NPI Number : 1154435881
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRINCETON FAMILY MEDICINE, PLLC
Provider Business Mailing Address
First Line : PO BOX 1589
Second Line :
City : PRINCETON
State : WV
Zip : 24740-1589
Country : US
Telephone Number : 304-431-7100
Fax Number : 304-431-7112
Provider Business Practice Location Address
First Line : 904 HARRISON ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-3011
Country : US
Telephone Number : 304-431-7100
Fax Number : 304-431-7112
Authorized Official
Title or Position : PHYSICIAN, OWNER
Name : DR. RYAN T. RUNYON
Credential : D.O.
Telephone Number : 304-431-7100
Provider Enumeration Date : 08/19/2006
Last Update Date : 08/22/2020

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Directions to “PRINCETON FAMILY MEDICINE, PLLC ” Practice Location

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