Organization Name: | JEFFERSON URGENT CARE, LLC |
NPI Number: | 1992726236 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DUANE C BAILEY (PRESIDENT) |
Mailing Address: | 84 Somerset Blvd Charles Town |
State: | WV US |
Postal Code: | 254144827 |
Phone Number: | 3047288543 |
Fax Number: | 3047288644 |
NPI Enumeration Date: | 07/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |