| Southway | |
|
4825 Maccorkle Ave Sw Suite D South Charleston WV 25309-1365 | |
| (304) 766-4560 | |
| (304) 766-4599 |
| Full Name | Southway |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4825 Maccorkle Ave Sw, South Charleston, West Virginia |
| Authorized Official Name and Position | Patrick L Fields (ADMINISTRATIVE DIRECTOR OF BHS) |
| Authorized Official Contact | 3047663441 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southway 4825 Maccorkle Ave Sw Suite D South Charleston WV 25309-1365 Ph: (304) 766-4560 | Southway 4825 Maccorkle Ave Sw Suite D South Charleston WV 25309-1365 Ph: (304) 766-4560 |
| NPI Number | 1790028744 |
|---|---|
| Provider Enumeration Date | 03/28/2013 |
| Last Update Date | 03/28/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790028744 | NPI | - | NPPES |
| 50090 | Medicaid | WV | |
| 0001391000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 109 (West Virginia) | Primary |
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