Basic Information
| Provider Information | |||||||||
| NPI: | 1235489931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRING MILLS MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | UNIVERSITY HEALTH ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 780 | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265070780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042857100 | ||||||||
| FaxNumber: | 3042936963 | ||||||||
| Practice Location | |||||||||
| Address1: | 1179 T J JACKSON DR | ||||||||
| Address2: | |||||||||
| City: | FALLING WATERS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254194698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048201031 | ||||||||
| FaxNumber: | 3048201033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2012 | ||||||||
| LastUpdateDate: | 10/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | RUMBLE | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3042857101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.