Provider Demographics
NPI:1134590532
Name:FINBAR G POWDERLY
Entity type:Organization
Organization Name:FINBAR G POWDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FINBAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:POWDERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-489-1222
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-0489
Mailing Address - Country:US
Mailing Address - Phone:304-489-1222
Mailing Address - Fax:304-489-1285
Practice Address - Street 1:1578 ELIZABETH PIKE
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150-0489
Practice Address - Country:US
Practice Address - Phone:304-489-1222
Practice Address - Fax:304-489-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care