Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 59 Ossia Rd, Duck, 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 |
---|---|
Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | 59 Ossia Rd Duck WV 25063-8500 Ph: (304) 286-2838 |
NPI Number | 1619103041 |
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Provider Enumeration Date | 05/29/2009 |
Last Update Date | 03/30/2022 |
Medicare PECOS PAC ID | 0648189258 |
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Medicare Enrollment ID | O20091201000701 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619103041 | NPI | - | NPPES |
3810017436 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |