MEDICARE: APPLE VALLEY FAMILY MEDICINE AND URGENT CARE

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	261QU0200X	Urgent Care Clinic/Center
2	207Q00000X	Family Medicine Physician	25370	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1427362383	OTHER	WV	NPI

General Provider Information

NPI Number	:	1558735209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLE VALLEY FAMILY MEDICINE AND URGENT CARE

Provider Business Mailing Address
First Line	:	202 FOXCROFT AVENUE
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401
Country	:	US
Telephone Number	:	240-476-0791
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 FOXCROFT AVE
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-5312
Country	:	US
Telephone Number	:	240-476-0791
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. KOLAWALE ADEDEJI OSHIYOYE
Credential	:	MD
Telephone Number	:	240-476-0791

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	01/16/2024

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Directions to “APPLE VALLEY FAMILY MEDICINE AND URGENT CARE ” Practice Location

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