| |
4 Northridge Dr Ste 118 Buckhannon WV 26201-8484 | |
(304) 473-5660 | |
(304) 473-5661 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4 Northridge Dr Ste 118, Buckhannon, West Virginia |
Authorized Official Name and Position | Richard G Simon (CEO) |
Authorized Official Contact | 3045450571 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4 Northridge Dr Ste 118 Buckhannon WV 26201-8484 Ph: (304) 473-5660 | 4 Northridge Dr Ste 118 Buckhannon WV 26201-8484 Ph: (304) 473-5660 |
NPI Number | 1255507810 |
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Provider Enumeration Date | 05/05/2008 |
Last Update Date | 01/19/2024 |
Medicare PECOS PAC ID | 0446232987 |
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Medicare Enrollment ID | O20080528000322 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255507810 | NPI | - | NPPES |
1255507810 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 34 N Kanawha St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-6699 | |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 33 E Victoria St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-5460 | |