LIVING WATERS MEDICAL CENTER NPI 1114585619

NPI Information

NPI: 1114585619
Provider Name: LIVING WATERS MEDICAL CENTER
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 51D2168544

Address:
100 MAIN AVE
LOGAN, WV
ZIP 25601
Phone: (304) 946-8350
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LIVING WATERS MEDICAL CENTER is a primary care clinic center in Logan, WV. LIVING WATERS MEDICAL CENTER NPI is 1114585619. The provider is registered as an organization entity type.

The provider's business location address is:

100 MAIN AVE
LOGAN, WV
ZIP 25601-323
Phone: (304) 946-8350

The provider's authorized official is Amber Ellis .
The authorized official title is Director/family Nurse Practitioner and has the following contact phone number (304) 946-8350.

The CLIA number assigned to this NPI record is 51D2168544 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/31/2019 and was last updated on 5/31/2019.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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