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1630 13th Ave Huntington WV 25701-3812 | |
| (304) 697-2014 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1630 13th Ave, Huntington, West Virginia |
| Authorized Official Name and Position | Mary-beth Brubeck (VICE PRESIDENT OF FINANCE / CFO) |
| Authorized Official Contact | 3045253334 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2585 3rd Ave Huntington WV 25703-1642 Ph: (304) 697-1396 | 1630 13th Ave Huntington WV 25701-3812 Ph: (304) 697-2014 |
| NPI Number | 1194790089 |
|---|---|
| Provider Enumeration Date | 02/22/2006 |
| Last Update Date | 03/31/2022 |
| Certification Date | 03/31/2022 |
| Medicare PECOS PAC ID | 9931017969 |
|---|---|
| Medicare Enrollment ID | O20030616000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194790089 | NPI | - | NPPES |
| 0035204000 | Medicaid | WV | |
| CJ2698 | Other | WV | RR MEDICARE GROUP |
| 0998738 | Medicaid | OH | |
| 7100050730 | Medicaid | KY |
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