Basic Information
| Provider Information | |||||||||
| NPI: | 1760404800 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH MANAGEMENT ASSOCIATES OF WV | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WILLIAMSON FAMILY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 COLLEGE HL | ||||||||
| Address2: | PO BOX 1958 | ||||||||
| City: | WILLIAMSON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 256613300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042352930 | ||||||||
| FaxNumber: | 3042352933 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 COLLEGE HL | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 256613300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042352930 | ||||||||
| FaxNumber: | 3042352933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | MELINDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ASST. PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3042350466 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | WV | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.