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75 Capon School St Capon Bridge WV 26711-9059 | |
| (304) 897-5915 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 75 Capon School St, Capon Bridge, West Virginia |
| Authorized Official Name and Position | Meredith Michelle Heishman (CREDENTIALING) |
| Authorized Official Contact | 3048975915 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 97 Baker WV 26801-0097 Ph: (304) 897-5915 | 75 Capon School St Capon Bridge WV 26711-9059 Ph: (304) 897-5915 |
| NPI Number | 1275200313 |
|---|---|
| Provider Enumeration Date | 08/26/2021 |
| Last Update Date | 09/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275200313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |