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408 Alexander Street Cedar Grove WV 25039 | |
| (304) 595-1770 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 408 Alexander Street, Cedar Grove, West Virginia |
| Authorized Official Name and Position | Richard Weinberger (CFO) |
| Authorized Official Contact | 3045253334 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1680 Huntington WV 25717-1680 Ph: () - | 408 Alexander Street Cedar Grove WV 25039 Ph: (304) 595-1770 |
| NPI Number | 1699740472 |
|---|---|
| Provider Enumeration Date | 02/23/2006 |
| Last Update Date | 08/02/2018 |
| Medicare PECOS PAC ID | 9931017969 |
|---|---|
| Medicare Enrollment ID | O20021230000015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699740472 | NPI | - | NPPES |
| 0264006 | Medicaid | OH | |
| CJ2698 | Other | WV | RR MEDICARE GROUP |
| 614938703 | Other | WV | BLACK LUNG |
| 13029802 | Medicaid | KY | |
| 0022971001 | Medicaid | WV |