Provider Demographics
NPI:1992162754
Name:CAPON BRIDGE FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:CAPON BRIDGE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAID
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-856-3185
Mailing Address - Street 1:2852 NORTHWESTERN PIKE
Mailing Address - Street 2:
Mailing Address - City:CAPON BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:26711-9052
Mailing Address - Country:US
Mailing Address - Phone:304-856-2525
Mailing Address - Fax:
Practice Address - Street 1:2852 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:CAPON BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:26711-9052
Practice Address - Country:US
Practice Address - Phone:304-856-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV81966163W00000X
WV21499207Q00000X
WVAPRN82384NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty