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100 Hospital Dr Ste 1 Petersburg WV 26847-9570 | |
(304) 257-1944 | |
(304) 257-9524 |
Full Name | |
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Speciality | Family Medicine |
Location | 100 Hospital Dr Ste 1, Petersburg, West Virginia |
Authorized Official Name and Position | Renee Nevada Johnson (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 5405360103 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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220 Campus Blvd Ste 200 Winchester VA 22601-2889 Ph: (540) 536-5100 | 100 Hospital Dr Ste 1 Petersburg WV 26847-9570 Ph: (304) 257-1944 |
NPI Number | 1093219628 |
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Provider Enumeration Date | 03/20/2018 |
Last Update Date | 12/30/2020 |
Identifier | Type | State | Issuer |
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1093219628 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (West Virginia) | Secondary |
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
208800000X | Urology | (* (Not Available)) | Secondary |
South Branch Hospitalist And Internal Medicine Group Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 65 Hospital Dr Ste 102, Petersburg, WV 26847 Phone: 304-257-2527 Fax: 304-257-1469 | |
Dewey F Bensenhaver Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Hc 30 Box 95, Petersburg, WV 26847 Phone: 304-257-1456 | |