Provider Demographics
NPI:1013071711
Name:CLAY RURAL MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:CLAY RURAL MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:SAHEB
Authorized Official - Last Name:JAMIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-587-2636
Mailing Address - Street 1:43 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:WV
Mailing Address - Zip Code:25043
Mailing Address - Country:US
Mailing Address - Phone:304-587-2636
Mailing Address - Fax:304-587-4789
Practice Address - Street 1:43 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043
Practice Address - Country:US
Practice Address - Phone:304-587-2636
Practice Address - Fax:304-587-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10485208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty