Provider Demographics
NPI:1760701668
Name:CHARLES E.PORTERFIELD
Entity Type:Organization
Organization Name:CHARLES E.PORTERFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:PORTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-255-5710
Mailing Address - Street 1:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-1307
Mailing Address - Country:US
Mailing Address - Phone:304-255-5710
Mailing Address - Fax:304-255-5702
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1211
Practice Address - Country:US
Practice Address - Phone:304-255-5710
Practice Address - Fax:304-255-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic