| Organization Name: | HEDGESVILLE HEALTHCARE CENTER PLLC |
| NPI Number: | 1205268414 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUSTIN GLASSFORD (PRESIDENT/OWNER) |
| Mailing Address: | 3790 Hedgesville Rd Ste H Hedgesville |
| State: | WV US |
| Postal Code: | 254276704 |
| Phone Number: | 3047547160 |
| Fax Number: | 3047547244 |
| NPI Enumeration Date: | 07/30/2013 |
| NPI Last Update Date: | 07/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 23659 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |