Organization Name: | ST. MARY'S HEALTH WAGON |
NPI Number: | 1487818902 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TERESA OWENS GARDNER (EXECUTIVE DIRECTOR) |
Mailing Address: | 233 Chase St. Clintwood |
State: | VA US |
Postal Code: | 24228 |
Phone Number: | 2769262254 |
Fax Number: | |
NPI Enumeration Date: | 07/14/2008 |
NPI Last Update Date: | 05/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 0024128995 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |