| Doctors Immedicare | |
|
1802 Harper Rd Ste 102 Beckley WV 25801 | |
| (304) 252-9211 | |
| (304) 252-9218 |
| Full Name | Doctors Immedicare |
|---|---|
| Speciality | Clinic/Center |
| Location | 1802 Harper Rd Ste 102, Beckley, West Virginia |
| Authorized Official Name and Position | Prakash Puranik (MEMBER) |
| Authorized Official Contact | 3042529211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Doctors Immedicare 1802 Harper Rd Ste 102 Beckley WV 25801-3376 Ph: (304) 252-9211 | Doctors Immedicare 1802 Harper Rd Ste 102 Beckley WV 25801 Ph: (304) 252-9211 |
| NPI Number | 1932190865 |
|---|---|
| Provider Enumeration Date | 10/31/2005 |
| Last Update Date | 02/06/2020 |
| Medicare PECOS PAC ID | 1456256239 |
|---|---|
| Medicare Enrollment ID | O20031204000691 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932190865 | NPI | - | NPPES |
| 970026849 | Other | WV | RR MCARE |
| 51D0235325 | Other | WV | CLIA |
| 75159 | Other | WV | CARELINK |
| 001707274 | Other | WV | BC |
| 28130 | Other | WV | COLA |
| 001894000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Prakash Puranik |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1538270590 PECOS PAC ID: 4385544683 Enrollment ID: I20040114000331 |
| Provider Name | Deborah L Marra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700877644 PECOS PAC ID: 4082650767 Enrollment ID: I20050705000115 |
| Provider Name | Tara L Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790028082 PECOS PAC ID: 5395972608 Enrollment ID: I20131212000343 |
| Provider Name | Melissa R Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063857126 PECOS PAC ID: 9931337649 Enrollment ID: I20131231001848 |
| Provider Name | Kristen Sisler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386289320 PECOS PAC ID: 2163841867 Enrollment ID: I20200930000374 |
| Provider Name | Michael Allen Beswick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164776589 PECOS PAC ID: 6406265719 Enrollment ID: I20210517001570 |
Family Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 25 Mallard Ct, Beckley, WV 25801 Phone: 304-929-6020 | |
Beckley-uha Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 Carriage Dr, Beckley, WV 25801 Phone: 304-255-1544 | |
Dtg Ii Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 Main St, Beckley, WV 25801 Phone: 800-268-7713 Fax: 415-704-3294 | |
Community Health Systems Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1129 S Fayette St, Beckley, WV 25801 Phone: 304-256-4604 | |
New River Health Association, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1804 Harper Rd Ste A, Beckley, WV 25801 Phone: 304-469-2905 | |
Gastroenterology Of Southern Wv Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1844 Harper Rd, Beckley, WV 25801 Phone: 304-250-0307 Fax: 304-250-0384 | |
Community Health Systems Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 202 Bill Barker Way, Beckley, WV 25801 Phone: 304-252-8324 |