Coal Mountain Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

COAL MOUNTAIN LABORATORY

Practice address

5321 Maccorkle Ave SE
Charleston, WV 25304-2221

Phone

(502) 235-5795

NPI assigned

Dec 30, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nick Pfeiffer

Title

Ceo

Phone

(502) 235-5795

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1073100582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10928 WORTHINGTON LN",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400599590",
            "telephone_number": "502-235-5795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5321 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253042221",
            "telephone_number": "502-235-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAL MOUNTAIN LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-30",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "PFEIFFER",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "502-235-5795"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heavenly Faith Clyburn
• Victoria Nicole Brooke Clyburn
• CMC Pharmacy, LLC
• CMC Pharmacy, LLC
• Cheyenne Coakley
• Brandee Nichole Coalson, COTA/L
• Jessica Coates
• Lisa Coates
• Carolyn Cobb
• Shaynah Lynn Cobb, PTA

• Clinical Medical Laboratory in Charleston, WV
• Providers in Charleston, WV by specialty
• Clinical Medical Laboratory in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.