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4202 Malden Dr Malden WV 25306-6442 | |
(304) 928-5144 | |
Not Available |
Full Name | |
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Speciality | Community/Behavioral Health |
Location | 4202 Malden Dr, Malden, West Virginia |
Authorized Official Name and Position | Jessica Ann Toath (MEDICAL DIRECTOR) |
Authorized Official Contact | 3049285144 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 8413 South Charleston WV 25303-0413 Ph: (304) 928-5144 | 4202 Malden Dr Malden WV 25306-6442 Ph: (304) 928-5144 |
NPI Number | 1902407034 |
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Provider Enumeration Date | 11/04/2020 |
Last Update Date | 07/28/2023 |
Certification Date | 07/28/2023 |
Medicare PECOS PAC ID | 7214339522 |
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Medicare Enrollment ID | O20210708003406 |
Identifier | Type | State | Issuer |
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1902407034 | NPI | - | NPPES |
1316593270 | Other | WV | JESSICA TOATH-CALLAHAN |
1902407034 | Medicaid | WV | |
DP00945150 | Other | WV | CHELSEA LEIGH CARTER LICSW |
Provider Name | Jessica Ann Toath-callahan |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1316593270 PECOS PAC ID: 9335479500 Enrollment ID: I20191001003274 |
Provider Name | Chelsea Leigh Carter |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1114468105 PECOS PAC ID: 3678904497 Enrollment ID: I20200512001253 |