Provider Demographics
NPI:1659956894
Name:MINERS CITY CLINIC
Entity Type:Organization
Organization Name:MINERS CITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:304-875-4005
Mailing Address - Street 1:PO BOX 931
Mailing Address - Street 2:
Mailing Address - City:WAR
Mailing Address - State:WV
Mailing Address - Zip Code:24892-0931
Mailing Address - Country:US
Mailing Address - Phone:304-888-4998
Mailing Address - Fax:
Practice Address - Street 1:14197 ROCKET BOYS DRIVE
Practice Address - Street 2:N/A
Practice Address - City:WAR
Practice Address - State:WV
Practice Address - Zip Code:24892
Practice Address - Country:US
Practice Address - Phone:304-888-4998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care