| |
33-37 W Main Street Buckhannon WV 26201-2235 | |
(304) 924-6262 | |
(304) 924-5460 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 33-37 W Main Street, Buckhannon, West Virginia |
Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 3045872541 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
33-37 W Main Street Buckhannon WV 26201-2236 Ph: (304) 924-6262 | 33-37 W Main Street Buckhannon WV 26201-2235 Ph: (304) 924-6262 |
NPI Number | 1891241030 |
---|---|
Provider Enumeration Date | 08/28/2016 |
Last Update Date | 11/29/2022 |
Medicare PECOS PAC ID | 0446232987 |
---|---|
Medicare Enrollment ID | O20161012002394 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891241030 | NPI | - | NPPES |
2289-7283 | Other | WV | STATE OF WV BUSINESS LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2289-7283 (West Virginia) | Primary |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 34 N Kanawha St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-6699 | |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 33 E Victoria St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-5460 | |