Crystal Bastin Md Llc | |
4820 Kentucky St South Charleston WV 25309-1310 | |
(304) 720-0390 | |
Not Available |
Full Name | Crystal Bastin Md Llc |
---|---|
Speciality | Family Medicine |
Location | 4820 Kentucky St, South Charleston, West Virginia |
Authorized Official Name and Position | Shannon G Davis (OFFICE MANAGER) |
Authorized Official Contact | 3047200390 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Crystal Bastin Md Llc 4820 Kentucky Street South Charleston WV 25309-1364 Ph: (304) 720-0390 | Crystal Bastin Md Llc 4820 Kentucky St South Charleston WV 25309-1310 Ph: (304) 720-0390 |
NPI Number | 1053539387 |
---|---|
Provider Enumeration Date | 04/23/2007 |
Last Update Date | 11/12/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053539387 | NPI | - | NPPES |
1801865001 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 20368 (West Virginia) | Primary |
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