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120 Medical Park Dr Ste 300 Bridgeport WV 26330-9012 | |
(304) 624-7200 | |
(304) 423-5302 |
Full Name | |
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Speciality | Family Medicine |
Location | 120 Medical Park Dr, Bridgeport, West Virginia |
Authorized Official Name and Position | Michael Tillman (CEO) |
Authorized Official Contact | 6813421600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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527 Medical Park Dr Ste 400 Bridgeport WV 26330-9008 Ph: (681) 342-3500 | 120 Medical Park Dr Ste 300 Bridgeport WV 26330-9012 Ph: (304) 624-7200 |
NPI Number | 1992155097 |
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Provider Enumeration Date | 06/20/2016 |
Last Update Date | 06/20/2016 |
Identifier | Type | State | Issuer |
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1992155097 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Medbrook Medical Associates Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1370 Johnson Avenue, Bridgeport, WV 26330 Phone: 304-842-7186 Fax: 304-842-9005 | |
Mountainstate Infectious Disease, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 215 W Main St Ste B, Bridgeport, WV 26330 Phone: 301-641-1822 Fax: 304-250-9933 | |