Provider Demographics
NPI:1194045237
Name:SPECTRUM FAMILY CARE, PLLC
Entity Type:Organization
Organization Name:SPECTRUM FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-397-5744
Mailing Address - Street 1:1401 HOSPITAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9237
Mailing Address - Country:US
Mailing Address - Phone:304-397-5744
Mailing Address - Fax:304-757-0964
Practice Address - Street 1:1401 HOSPITAL DR
Practice Address - Street 2:SUITE 306
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9237
Practice Address - Country:US
Practice Address - Phone:304-397-5744
Practice Address - Fax:304-757-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018383Medicaid