Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 99 Horseshoe Dr, Philippi, West Virginia |
Authorized Official Name and Position | Eric A Ruf (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3048231333 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
70 N Sturmer St Belington WV 26250-7403 Ph: (304) 823-2800 | 99 Horseshoe Dr Philippi WV 26416 Ph: (304) 457-4000 |
NPI Number | 1205096039 |
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Provider Enumeration Date | 06/16/2008 |
Last Update Date | 01/13/2022 |
Medicare PECOS PAC ID | 9335171834 |
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Medicare Enrollment ID | O20080703000604 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205096039 | NPI | - | NPPES |
3810014224 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |