| Forefront Telecare Medical Services Pc | |
|
1627 Quarrier St Charleston WV 25311-2124 | |
| (866) 959-2008 | |
| (888) 972-2903 |
| Full Name | Forefront Telecare Medical Services Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1627 Quarrier St, Charleston, West Virginia |
| Authorized Official Name and Position | Sara Vitullo (DIRECTOR OF PAYER OPERATIONS) |
| Authorized Official Contact | 8669592008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Forefront Telecare Medical Services Pc 1717 Main St Ste 5850 Dallas TX 75201-7317 Ph: (866) 959-2008 | Forefront Telecare Medical Services Pc 1627 Quarrier St Charleston WV 25311-2124 Ph: (866) 959-2008 |
| NPI Number | 1629698766 |
|---|---|
| Provider Enumeration Date | 04/18/2020 |
| Last Update Date | 10/18/2024 |
| Certification Date | 10/18/2024 |
| Medicare PECOS PAC ID | 0446668826 |
|---|---|
| Medicare Enrollment ID | O20210423001611 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629698766 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Lloyd Esene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013542158 PECOS PAC ID: 7911337910 Enrollment ID: I20230720000956 |
| Provider Name | Bryan Jaye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750707337 PECOS PAC ID: 9436374329 Enrollment ID: I20230907003657 |
| Provider Name | Blake Henchcliffe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982191409 PECOS PAC ID: 2062848617 Enrollment ID: I20231110000654 |
| Provider Name | Andrew Venters Owens |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194168161 PECOS PAC ID: 5496051898 Enrollment ID: I20231130000672 |
| Provider Name | Elizabeth Umemba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184276503 PECOS PAC ID: 6800208760 Enrollment ID: I20231223000014 |
| Provider Name | Olga Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609275312 PECOS PAC ID: 7416176821 Enrollment ID: I20240405002000 |
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