ACTIVATE HEALTHCARE - TEAMSTERS 175 & 505 CLINIC NPI 1578922878

NPI Information

ACTIVATE HEALTHCARE - TEAMSTERS 175 & 505 CLINIC is a primary care clinic center in South Charleston, WV. ACTIVATE HEALTHCARE - TEAMSTERS 175 & 505 CLINIC NPI is 1578922878. The provider is registered as an organization entity type.

The provider's business location address is:

428 DIVISION ST
SUITE 2
SOUTH CHARLESTON, WV
ZIP 25309-469
Phone: (304) 768-0321
Fax: (304) 768-0322

The provider's authorized official is Debra Geihsler .
The authorized official title is Principal and has the following contact phone number (773) 697-3144.

The CLIA number assigned to this NPI record is 15D2074394 - other - chronic mgt with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/15/2016 and was last updated on 2/15/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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