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900 Independence Road Coal City WV 25823-1240 | |
(304) 683-6904 | |
(304) 683-6903 |
Full Name | |
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Speciality | Clinic/Center |
Location | 900 Independence Road, Coal City, West Virginia |
Authorized Official Name and Position | John R. Schultz (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3044692905 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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497 Mall Rd Oak Hill WV 25901-6216 Ph: () - | 900 Independence Road Coal City WV 25823-1240 Ph: (304) 683-6904 |
NPI Number | 1235436478 |
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Provider Enumeration Date | 02/24/2011 |
Last Update Date | 10/09/2023 |
Medicare PECOS PAC ID | 2365348596 |
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Medicare Enrollment ID | O20110315000129 |
Identifier | Type | State | Issuer |
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1235436478 | NPI | - | NPPES |
3810020948 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1036-9138 (West Virginia) | Primary |