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2 Chateau Ln Barboursville WV 25504-1626 | |
| (304) 736-9662 | |
| (304) 757-3252 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2 Chateau Ln, Barboursville, West Virginia |
| Authorized Official Name and Position | Julie Dianne Ray (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3047576999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
97 Great Teays Blvd Ste 6 Scott Depot WV 25560-9815 Ph: (304) 757-6999 | 2 Chateau Ln Barboursville WV 25504-1626 Ph: (304) 736-9662 |
| NPI Number | 1447618327 |
|---|---|
| Provider Enumeration Date | 02/05/2016 |
| Last Update Date | 05/24/2022 |
| Certification Date | 05/24/2022 |
| Medicare PECOS PAC ID | 4587568134 |
|---|---|
| Medicare Enrollment ID | O20160310001824 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447618327 | NPI | - | NPPES |
| 1447618327 | Medicaid | WV |
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