| Delta Lifestyle Solutions | |
|
109 Tolley Dr Bridgeport WV 26330-1669 | |
| (304) 623-6300 | |
| (304) 623-6302 |
| Full Name | Delta Lifestyle Solutions |
|---|---|
| Speciality | Family Medicine |
| Location | 109 Tolley Dr, Bridgeport, West Virginia |
| Authorized Official Name and Position | Mary Hackney (OWNER) |
| Authorized Official Contact | 3046236300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Delta Lifestyle Solutions Po Box 4246 Clarksburg WV 26302-4246 Ph: (304) 623-6300 | Delta Lifestyle Solutions 109 Tolley Dr Bridgeport WV 26330-1669 Ph: (304) 623-6300 |
| NPI Number | 1619579208 |
|---|---|
| Provider Enumeration Date | 11/10/2020 |
| Last Update Date | 11/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619579208 | NPI | - | NPPES |
| 1639326747 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QA0401X | Family Medicine - Addiction Medicine | (* (Not Available)) | Secondary |
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