Provider Demographics
NPI:1497161624
Name:COUNTRY DOCTORS FAMILY MEDICINE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:COUNTRY DOCTORS FAMILY MEDICINE PROFESSIONAL CORPORATION
Other - Org Name:COUNTRY DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-864-4362
Mailing Address - Street 1:658 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-0000
Mailing Address - Country:US
Mailing Address - Phone:304-864-4362
Mailing Address - Fax:304-864-4366
Practice Address - Street 1:658 BURKE RD
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:WV
Practice Address - Zip Code:26542-0000
Practice Address - Country:US
Practice Address - Phone:304-864-4362
Practice Address - Fax:304-864-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty