| Bridgeport Express Care Inc | |
|
2 Chenoweth Dr Bridgeport WV 26330-1688 | |
| (304) 599-3129 | |
| Not Available |
| Full Name | Bridgeport Express Care Inc |
|---|---|
| Speciality | General Practice |
| Location | 2 Chenoweth Dr, Bridgeport, West Virginia |
| Authorized Official Name and Position | Timothy Peasak (PRESIDENT) |
| Authorized Official Contact | 3045993129 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeport Express Care Inc 2 Chenoweth Dr Bridgeport WV 26330-1688 Ph: (304) 599-3129 | Bridgeport Express Care Inc 2 Chenoweth Dr Bridgeport WV 26330-1688 Ph: (304) 599-3129 |
| NPI Number | 1912142001 |
|---|---|
| Provider Enumeration Date | 12/04/2008 |
| Last Update Date | 01/26/2009 |
| Medicare PECOS PAC ID | 8325104896 |
|---|---|
| Medicare Enrollment ID | O20090309000095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912142001 | NPI | - | NPPES |
| 3810013952 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Timothy Michael Peasak |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720142391 PECOS PAC ID: 0446242549 Enrollment ID: I20040331000049 |
| Provider Name | David Paul Peasak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316987001 PECOS PAC ID: 9335137074 Enrollment ID: I20040503001023 |
| Provider Name | Natalie R King-selario |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225214240 PECOS PAC ID: 3577619097 Enrollment ID: I20090924000003 |
| Provider Name | Maria Bridgette Scudere |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962036509 PECOS PAC ID: 7416388871 Enrollment ID: I20200519001947 |
| Provider Name | Travis Lee Wamsley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295406833 PECOS PAC ID: 7618365271 Enrollment ID: I20211101001578 |
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