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1 Mott Street Harman WV 26270-0014 | |
(304) 227-4134 | |
(304) 227-4522 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1 Mott Street, Harman, West Virginia |
Authorized Official Name and Position | Jamie Hudson (CEO) |
Authorized Official Contact | 3043582355 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Drawer 14 Harman WV 26270-0014 Ph: (304) 227-4134 | 1 Mott Street Harman WV 26270-0014 Ph: (304) 227-4134 |
NPI Number | 1427307222 |
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Provider Enumeration Date | 09/07/2012 |
Last Update Date | 06/14/2016 |
Medicare PECOS PAC ID | 3678470614 |
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Medicare Enrollment ID | O20121114000473 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427307222 | NPI | - | NPPES |
3810026188 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |