Organization Name: | WILLIAM CONRAD INC. |
NPI Number: | 1831447499 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM BENJAMIN CONRAD (PRESIDENT) |
Mailing Address: | 154 Oak View Ln New Creek |
State: | WV US |
Postal Code: | 267434544 |
Phone Number: | 3047909344 |
Fax Number: | 3047887760 |
NPI Enumeration Date: | 08/29/2012 |
NPI Last Update Date: | 03/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | WV 1053-OD |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |