| Bridgeport Middle School Wellness Center | |
|
413 Johnson Ave Bridgeport WV 26330-1309 | |
| (304) 326-7142 | |
| (304) 587-2594 |
| Full Name | Bridgeport Middle School Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 413 Johnson Ave, Bridgeport, West Virginia |
| Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
| Authorized Official Contact | 3045872541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeport Middle School Wellness Center Po Box 147 Clay WV 25043-0147 Ph: (304) 587-2541 | Bridgeport Middle School Wellness Center 413 Johnson Ave Bridgeport WV 26330-1309 Ph: (304) 326-7142 |
| NPI Number | 1669868931 |
|---|---|
| Provider Enumeration Date | 04/13/2015 |
| Last Update Date | 04/13/2015 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20150601002612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669868931 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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