| Community Care Of West Virginia, Inc. | |
|
34 N Kanawha St Buckhannon WV 26201-2714 | |
| (304) 924-6262 | |
| (304) 924-6699 |
| Full Name | Community Care Of West Virginia, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 34 N Kanawha St, Buckhannon, West Virginia |
| Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 3045615319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care Of West Virginia, Inc. 34 N Kanawha St Buckhannon WV 26201-2714 Ph: (304) 924-6262 | Community Care Of West Virginia, Inc. 34 N Kanawha St Buckhannon WV 26201-2714 Ph: (304) 924-6262 |
| NPI Number | 1063048189 |
|---|---|
| Provider Enumeration Date | 03/20/2020 |
| Last Update Date | 03/20/2020 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20200427002070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063048189 | NPI | - | NPPES |
| 2386-2367 | Other | WV | WEST VIRGINIA BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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