Crystal Bastin Md Llc

LBN: Crystal Bastin Md Llc
Crystal Bastin Md Llc is an health care organization with primary practice located at 4820 Kentucky St , South Charleston WV 25309-1310. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Crystal Bastin Md Llc can be contacted via phone (304) 720-0390, or through Davis, Shannon G via phone (304) 720-0390.

Contact Information

Primary practice address
4820 Kentucky St South Charleston WV 25309-1310
Phone: (304) 720-0390
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Davis, Shannon G
Phone: (304) 720-0390

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 20368 West Virginia

Profile Details

NPI number 1053539387
LBN Legal business name Crystal Bastin Md Llc
DBA Doing business as
Authorized official Davis, Shannon G
Entity Organization
Organization subpart 1 No
Enumeration date Apr 23rd, 2007
Last updated Nov 12th, 2013 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053539387 NPPES
West Virginia MEDICAID 1801865001

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