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One Panther Drive Clay WV 25043-0729 | |
(304) 587-2867 | |
(304) 587-2867 |
Full Name | |
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Speciality | Clinic/Center |
Location | One Panther Drive, Clay, West Virginia |
Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 3043177275 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 147 Clay WV 25043-0147 Ph: (304) 587-7301 | One Panther Drive Clay WV 25043-0729 Ph: (304) 587-2867 |
NPI Number | 1992755789 |
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Provider Enumeration Date | 05/11/2006 |
Last Update Date | 09/08/2020 |
Medicare PECOS PAC ID | 0446232987 |
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Medicare Enrollment ID | O20120904000402 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992755789 | NPI | - | NPPES |
001979216 | Other | WV | MS BCBS |
0035189006 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2267-4838 (West Virginia) | Primary |
Clay Rural Medical Clinic Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 43 Main Street, Clay, WV 25043 Phone: 304-587-2636 Fax: 304-587-4789 | |
Physician Management Services Of West Virginia, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 122 Center St, Clay, WV 25043 Phone: 888-829-8550 |