| Willow Ridge Pllc | |
|
333 N Jefferson St Lewisburg WV 24901-1116 | |
| (304) 645-7503 | |
| (304) 645-7582 |
| Full Name | Willow Ridge Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 333 N Jefferson St, Lewisburg, West Virginia |
| Authorized Official Name and Position | Rhonda Lynette Hamm (OWNER/PHYSICIAN) |
| Authorized Official Contact | 3046457503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Ridge Pllc 333 N Jefferson St Lewisburg WV 24901-1116 Ph: (304) 645-7503 | Willow Ridge Pllc 333 N Jefferson St Lewisburg WV 24901-1116 Ph: (304) 645-7503 |
| NPI Number | 1629241880 |
|---|---|
| Provider Enumeration Date | 04/09/2008 |
| Last Update Date | 07/09/2008 |
| Medicare PECOS PAC ID | 7416036033 |
|---|---|
| Medicare Enrollment ID | O20080508000136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629241880 | NPI | - | NPPES |
| 3810001633 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Rhonda L Hamm |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538184429 PECOS PAC ID: 7810978145 Enrollment ID: I20040825000359 |
| Provider Name | Rachel Leah Levan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497901557 PECOS PAC ID: 6103960984 Enrollment ID: I20120516000105 |
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