Provider Demographics
NPI:1497965461
Name:WESTMORELAND FAMILY CARE CENTER, INC
Entity Type:Organization
Organization Name:WESTMORELAND FAMILY CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WESTMORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-773-5333
Mailing Address - Street 1:16 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:WV
Mailing Address - Zip Code:25260-9677
Mailing Address - Country:US
Mailing Address - Phone:304-773-5333
Mailing Address - Fax:304-773-5885
Practice Address - Street 1:16 2ND ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:WV
Practice Address - Zip Code:25260-9677
Practice Address - Country:US
Practice Address - Phone:304-773-5333
Practice Address - Fax:304-773-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0639572Medicaid
WV0040703000Medicaid
WV0040703000Medicaid
WVE05969Medicare UPIN