MEDICARE: MRS. LORI L BETLER PA-C

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
1	363AM0700X	Medical Physician Assistant	00503	WV

General Provider Information

NPI Number	:	1285801571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI L BETLER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 2630
Second Line	:	CENTRAL WV MEDCORP, INC.
City	:	ELKINS
State	:	WV
Zip	:	26241-2630
Country	:	US
Telephone Number	:	304-637-6302
Fax Number	:	304-637-6307

Provider Business Practice Location Address
First Line	:	100 SENECA RD
Second Line	:	TYGART VALLEY ENT ASSOCIATES
City	:	ELKINS
State	:	WV
Zip	:	26241-9709
Country	:	US
Telephone Number	:	304-637-6302
Fax Number	:	304-637-6307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	04/14/2010

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