| Charleston Internal Medicine Inc | |
|
3701 Maccorkle Ave Se Charleston WV 25304-1525 | |
| (304) 720-2345 | |
| (304) 720-2347 |
| Full Name | Charleston Internal Medicine Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3701 Maccorkle Ave Se, Charleston, West Virginia |
| Authorized Official Name and Position | Roy Thomas Bowden (PRESIDENT AND OWNER) |
| Authorized Official Contact | 3047202345 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charleston Internal Medicine Inc 3701 Maccorkle Ave Se Charleston WV 25304-1525 Ph: (304) 720-2345 | Charleston Internal Medicine Inc 3701 Maccorkle Ave Se Charleston WV 25304-1525 Ph: (304) 720-2345 |
| NPI Number | 1033206263 |
|---|---|
| Provider Enumeration Date | 10/09/2006 |
| Last Update Date | 10/04/2022 |
| Medicare PECOS PAC ID | 5698745230 |
|---|---|
| Medicare Enrollment ID | O20040729001266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033206263 | NPI | - | NPPES |
| 3810004289 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Roy T Bowden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174594642 PECOS PAC ID: 4789576950 Enrollment ID: I20040325000356 |
| Provider Name | Tracie F Bonner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679709554 PECOS PAC ID: 5799838959 Enrollment ID: I20090805000480 |
| Provider Name | Lauren M Linville |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760890412 PECOS PAC ID: 5799905352 Enrollment ID: I20141001002817 |
| Provider Name | Jade Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487192159 PECOS PAC ID: 7911274147 Enrollment ID: I20170518001839 |
| Provider Name | Melissa Sue Rainey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689235798 PECOS PAC ID: 1456680735 Enrollment ID: I20190911003230 |
| Provider Name | Megan Ashley Perraut |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447929013 PECOS PAC ID: 8820486459 Enrollment ID: I20211101000550 |
| Provider Name | Brijal P Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043598063 PECOS PAC ID: 0042439259 Enrollment ID: I20220204002284 |
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