Braxton Primary Health Care | |
110 Municipal Street Burnsville WV 26335-0424 | |
(304) 853-2278 | |
(304) 853-2520 |
Full Name | Braxton Primary Health Care |
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Speciality | Internal Medicine |
Location | 110 Municipal Street, Burnsville, West Virginia |
Authorized Official Name and Position | Antoine Katiny (OWNER) |
Authorized Official Contact | 3048532278 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Braxton Primary Health Care 110 Municipal Street Po Box 424 Burnsville WV 26335-0424 Ph: (304) 853-2278 | Braxton Primary Health Care 110 Municipal Street Burnsville WV 26335-0424 Ph: (304) 853-2278 |
NPI Number | 1619090743 |
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Provider Enumeration Date | 04/06/2007 |
Last Update Date | 10/05/2010 |
Medicare PECOS PAC ID | 8022104900 |
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Medicare Enrollment ID | O20071024000100 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619090743 | NPI | - | NPPES |
0034771000 | Medicaid | WV | |
0075944000 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 17332 (West Virginia) | Primary |
Provider Name | Antoine Katiny |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1407816416 PECOS PAC ID: 2062508948 Enrollment ID: I20071024000057 |
Burnsville Elementary School Wellness Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 228 Kanawha Avenue, Burnsville, WV 26335 Phone: 304-924-6262 Fax: 304-924-5460 |