| Chesapeake Healthcare Center | |
|
11950 Maccorkle Ave Chesapeake WV 25315-1135 | |
| (304) 690-3802 | |
| Not Available |
| Full Name | Chesapeake Healthcare Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 11950 Maccorkle Ave, Chesapeake, West Virginia |
| Authorized Official Name and Position | Genise L Lalos (OWNER) |
| Authorized Official Contact | 3046903802 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chesapeake Healthcare Center 5054 Bennington Dr Charleston WV 25313-2051 Ph: (304) 690-3802 | Chesapeake Healthcare Center 11950 Maccorkle Ave Chesapeake WV 25315-1135 Ph: (304) 690-3802 |
| NPI Number | 1790279651 |
|---|---|
| Provider Enumeration Date | 06/14/2018 |
| Last Update Date | 06/14/2018 |
| Medicare PECOS PAC ID | 5496090037 |
|---|---|
| Medicare Enrollment ID | O20181231000109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790279651 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | William M Harris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891772802 PECOS PAC ID: 5799773511 Enrollment ID: I20040503000179 |
| Provider Name | Jennifer Lynn Mccracken |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982143657 PECOS PAC ID: 5496023434 Enrollment ID: I20170616000733 |
| Provider Name | Joshua L Shrewsbery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144561432 PECOS PAC ID: 7517314305 Enrollment ID: I20231116000767 |