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11 School Loop Rd Hacker Valley WV 26222-8463 | |
(304) 226-5725 | |
(304) 226-3274 |
Full Name | |
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Speciality | Clinic/Center |
Location | 11 School Loop Rd, Hacker Valley, West Virginia |
Authorized Official Name and Position | Margaret Hickey (CEO) |
Authorized Official Contact | 3042265725 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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10003 Webster Rd Camden On Gauley WV 26208-7713 Ph: (304) 226-5725 | 11 School Loop Rd Hacker Valley WV 26222-8463 Ph: (304) 226-5725 |
NPI Number | 1053018887 |
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Provider Enumeration Date | 02/13/2023 |
Last Update Date | 12/15/2023 |
Medicare PECOS PAC ID | 6002867850 |
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Medicare Enrollment ID | O20230426000908 |
Identifier | Type | State | Issuer |
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1053018887 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |