| Familycare Health Center | |
|
12 Kanawha Ter Saint Albans WV 25177-2750 | |
| (304) 757-7711 | |
| (304) 757-3252 |
| Full Name | Familycare Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 12 Kanawha Ter, Saint Albans, West Virginia |
| Authorized Official Name and Position | Julie Dianne Ray (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3047576999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Familycare Health Center 97 Great Teays Blvd Ste 6 Scott Depot WV 25560-9816 Ph: (304) 757-9999 | Familycare Health Center 12 Kanawha Ter Saint Albans WV 25177-2750 Ph: (304) 757-7711 |
| NPI Number | 1902166945 |
|---|---|
| Provider Enumeration Date | 05/24/2012 |
| Last Update Date | 05/24/2022 |
| Medicare PECOS PAC ID | 4587568134 |
|---|---|
| Medicare Enrollment ID | O20120907000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902166945 | NPI | - | NPPES |
| 1902166945 | Medicaid | WV | |
| 3810024408 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2271-2224 (West Virginia) | Primary |
| Provider Name | Henry Derbes |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1912434978 PECOS PAC ID: 7911389622 Enrollment ID: I20230724000718 |
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