| |
401 Vermillion St. Athens WV 24712 | |
(304) 384-7325 | |
(304) 384-8870 |
Full Name | |
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Speciality | Family Medicine |
Location | 401 Vermillion St., Athens, West Virginia |
Authorized Official Name and Position | Omar R Kassem (PHYSICIAN) |
Authorized Official Contact | 3043847325 |
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 697 Athens WV 24712-0697 Ph: (304) 384-7325 | 401 Vermillion St. Athens WV 24712 Ph: (304) 384-7325 |
NPI Number | 1972610863 |
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Provider Enumeration Date | 08/24/2006 |
Last Update Date | 12/08/2023 |
Medicare PECOS PAC ID | 3678482221 |
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Medicare Enrollment ID | O20031216000138 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972610863 | NPI | - | NPPES |
0034866000 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 20079 (West Virginia) | Primary |