Provider Demographics
NPI:1659574382
Name:KANAWHA VALLEY INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:KANAWHA VALLEY INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPURLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-720-3600
Mailing Address - Street 1:15 QUAIL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4570
Mailing Address - Country:US
Mailing Address - Phone:304-345-3228
Mailing Address - Fax:
Practice Address - Street 1:3418 STAUNTON AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1327
Practice Address - Country:US
Practice Address - Phone:304-720-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty