Provider Demographics
NPI:1861066276
Name:PRICE, MACEY
Entity type:Individual
Prefix:
First Name:MACEY
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MIDLAND TRAIL
Mailing Address - Street 2:
Mailing Address - City:BOOMER
Mailing Address - State:WV
Mailing Address - Zip Code:25031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 BROOKS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2903
Practice Address - Country:US
Practice Address - Phone:304-766-9669
Practice Address - Fax:304-720-1014
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant