Provider Demographics
NPI:1528284247
Name:WV FAMILY MEDICINE,INC
Entity type:Organization
Organization Name:WV FAMILY MEDICINE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARUNASREE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-831-0085
Mailing Address - Street 1:1115 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3309
Mailing Address - Country:US
Mailing Address - Phone:304-831-0085
Mailing Address - Fax:304-831-0088
Practice Address - Street 1:1115 2ND AVE
Practice Address - Street 2:
Practice Address - City:WEST LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3309
Practice Address - Country:US
Practice Address - Phone:304-831-0085
Practice Address - Fax:304-831-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
WV22060261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003597Medicaid
WVH72012Medicare UPIN
WV3810003597Medicaid