Organization · NPI-2

Ideal Option, PLLC

Clinic/Center · Morgantown, WV

NPI number1265954895

StatusActive

Last updated in NPPESAug 30, 2023

Details

NPI: 1265954895
Entity type: Organization (NPI-2)
Legal business name: Ideal Option, PLLC
Organization subpart: No
Enumeration date: Jul 14, 2017
Certification date: Aug 30, 2023
Last updated: Aug 30, 2023

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261Q00000X	Clinic/Center	–	–	Yes
207QA0401X	Family Medicine, Addiction Medicine	–	–

Practice location

1195 Pineview Dr
Morgantown, WV 26505-0482

Phone 877-522-1275 · Fax 509-491-3031

Mailing address

8656 W Gage Blvd St 301b
Kennewick, WA 99336-7145

Phone 509-222-1275 · Fax 509-491-3031

Authorized official

Brian Jefferson Dawson
Cmo
5092221275

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