| |
5861 Mason Dixon Hwy Blacksville WV 26521 | |
(304) 432-8211 | |
(304) 432-8213 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 5861 Mason Dixon Hwy, Blacksville, West Virginia |
Authorized Official Name and Position | Rebecca J Thomas (CEO) |
Authorized Official Contact | 3044328211 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 72 Blacksville WV 26521-0072 Ph: (304) 432-8211 | 5861 Mason Dixon Hwy Blacksville WV 26521 Ph: (304) 432-8211 |
NPI Number | 1215092473 |
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Provider Enumeration Date | 12/27/2006 |
Last Update Date | 08/25/2021 |
Identifier | Type | State | Issuer |
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1215092473 | NPI | - | NPPES |
0035288006 | Medicaid | WV |