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514 Hendricks Street Wayne WV 25570-0729 | |
(304) 272-3005 | |
(304) 272-3335 |
Full Name | |
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Speciality | Clinic/center |
Location | 514 Hendricks Street, Wayne, West Virginia |
Authorized Official Name and Position | Michael E Kilkenny (OWNER) |
Authorized Official Contact | 3042723005 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 729 Wayne WV 25570-0729 Ph: (304) 272-3005 | 514 Hendricks Street Wayne WV 25570-0729 Ph: (304) 272-3005 |
NPI Number | 1639264146 |
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Provider Enumeration Date | 10/03/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1639264146 | NPI | - | NPPES |
0050099000 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 13536 (West Virginia) | Primary |