Provider Demographics
NPI:1528269248
Name:COUNTY OF PRESTON BOARD OF HEALTH
Entity type:Organization
Organization Name:COUNTY OF PRESTON BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:304-329-0096
Mailing Address - Street 1:106 W MAIN ST
Mailing Address - Street 2:UNIT 203
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1131
Mailing Address - Country:US
Mailing Address - Phone:304-329-0096
Mailing Address - Fax:304-329-3103
Practice Address - Street 1:106 W MAIN ST
Practice Address - Street 2:UNIT 203
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1131
Practice Address - Country:US
Practice Address - Phone:304-329-0096
Practice Address - Fax:304-329-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021461003OtherFAMILY PLANNING
WV0021461000Medicaid
0021461001OtherRFTS
0021461001OtherRFTS
WV0021461000Medicaid
WV0021461000Medicaid