Provider Demographics
NPI:1962876110
Name:PRESTON-TAYLOR COMMUNITY HEALTH CENTERS INCORPORATED
Entity type:Organization
Organization Name:PRESTON-TAYLOR COMMUNITY HEALTH CENTERS INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-463-4200
Mailing Address - Street 1:30 CORTLAND ACRES LN
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:WV
Mailing Address - Zip Code:26292-8066
Mailing Address - Country:US
Mailing Address - Phone:304-463-4200
Mailing Address - Fax:304-463-4201
Practice Address - Street 1:30 CORTLAND ACRES LN
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:WV
Practice Address - Zip Code:26292-8066
Practice Address - Country:US
Practice Address - Phone:304-463-4200
Practice Address - Fax:304-463-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVMP0552420333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155503OtherPK