| Fayette Clinic, Pllc | |
|
1 Physicians Plaza Lochgelly WV 25866 | |
| (304) 469-3334 | |
| Not Available |
| Full Name | Fayette Clinic, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1 Physicians Plaza, Lochgelly, West Virginia |
| Authorized Official Name and Position | Darlene Newell (OFFICE MANAGER) |
| Authorized Official Contact | 3044693334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fayette Clinic, Pllc 1 Physicians Plaza Po Box 130 Lochgelly WV 25866 Ph: (304) 469-3334 | Fayette Clinic, Pllc 1 Physicians Plaza Lochgelly WV 25866 Ph: (304) 469-3334 |
| NPI Number | 1851580468 |
|---|---|
| Provider Enumeration Date | 10/19/2007 |
| Last Update Date | 06/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851580468 | NPI | - | NPPES |
| 0206041003 | Medicaid | WV | |
| 200164 | Other | WV | FEDERAL BLACK LUNG |
| 0206041000 | Medicaid | WV | |
| 513906 | Other | WV | RURAL HEALTH PROVIDER # |
| 001708474 | Other | WV | BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (West Virginia) | Primary |
| 363L00000X | Nurse Practitioner | (West Virginia) | Secondary |