Organization Name: | DR. RICK L HOUDERSHELDT, INC |
NPI Number: | 1003072398 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICK L HOUDERSHELDT (CEO) |
Mailing Address: | 3705 Teays Valley Rd Suite 202 Hurricane |
State: | WV US |
Postal Code: | 255268757 |
Phone Number: | 3047576990 |
Fax Number: | 3047570911 |
NPI Enumeration Date: | 08/06/2008 |
NPI Last Update Date: | 06/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 789 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |