Community Care Of Big Otter is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Ivydale, West Virginia. The current practice location for Community Care Of Big Otter is 797 Clinic Dr, Ivydale, West Virginia. For appointments, you can reach them via phone at
(304) 286-4200. The mailing address for Community Care Of Big Otter is Po Box 147, Clay, West Virginia and phone number is (304) 587-7301.
Community Care Of Big Otter is licensed to practice in West Virginia (license number 550630765002). The clinic also participates in the medicare program and its
NPI number is 1992754592. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(304) 286-4200.
Primary Care Clinic Profile
| Full Name | Community Care Of Big Otter |
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| Speciality | Clinic/Center |
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| Location | 797 Clinic Dr, Ivydale, West Virginia |
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| Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
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| Authorized Official Contact | 3045872541 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Community Care Of Big Otter
Po Box 147
Clay
WV 25043-0147
Ph: (304) 587-7301 | Community Care Of Big Otter
797 Clinic Dr
Ivydale
WV 25113-8263
Ph: (304) 286-4200 |
NPI Details:
| NPI Number | 1992754592 |
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| Provider Enumeration Date | 05/09/2006 |
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| Last Update Date | 01/19/2024 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 0446232987 |
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| Medicare Enrollment ID | O20120904000371 |
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Medical Identifiers
Medical identifiers for Community Care Of Big Otter such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1992754592 | NPI | - | NPPES |
| 001898548 | Other | WV | MS BCBS |
| 0035398000 | Medicaid | WV | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550630765002 (West Virginia) | Primary |
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