Provider Demographics
NPI:1508962754
Name:CHEAT LAKE URGENT CARE PLLC
Entity Type:Organization
Organization Name:CHEAT LAKE URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-291-5533
Mailing Address - Street 1:710 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-7306
Mailing Address - Country:US
Mailing Address - Phone:304-291-5533
Mailing Address - Fax:304-291-5548
Practice Address - Street 1:710 VENTURE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-7306
Practice Address - Country:US
Practice Address - Phone:304-291-5533
Practice Address - Fax:304-291-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care