Provider Demographics
NPI:1972594844
Name:KAREN HULTMAN INC
Entity Type:Organization
Organization Name:KAREN HULTMAN INC
Other - Org Name:FAMILY MEDICAL KARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HULTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-574-2600
Mailing Address - Street 1:439 ELIZABETH HWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-6865
Mailing Address - Country:US
Mailing Address - Phone:304-574-2600
Mailing Address - Fax:304-574-2951
Practice Address - Street 1:439 ELIZABETH HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-6865
Practice Address - Country:US
Practice Address - Phone:304-574-2600
Practice Address - Fax:304-574-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDA4369OtherRR MCARE
WV001705906OtherBC
WVDA4369OtherRR MCARE
WVE05962Medicare UPIN