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1349 Shinnston Pike Clarksburg WV 26301-6307 | |
(304) 622-0115 | |
(304) 623-6220 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1349 Shinnston Pike, Clarksburg, West Virginia |
Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 3043177275 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1349 Shinnston Pike Clarksburg WV 26301-6307 Ph: (304) 622-0115 | 1349 Shinnston Pike Clarksburg WV 26301-6307 Ph: (304) 622-0115 |
NPI Number | 1669923538 |
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Provider Enumeration Date | 10/17/2016 |
Last Update Date | 07/25/2023 |
Medicare PECOS PAC ID | 0446232987 |
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Medicare Enrollment ID | O20161130002673 |
Identifier | Type | State | Issuer |
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1669923538 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Veterans Health Administration Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 Med Center Dr, Clarksburg, WV 26301 Phone: 304-623-3461 | |
Ucfa Physicians Network Group Of West Virginia Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2413 E Pike St, Clarksburg, WV 26301 Phone: 423-271-9911 | |