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167 Gawthrop Rd Buckhannon WV 26201-3927 | |
(304) 473-5690 | |
(304) 473-5692 |
Full Name | |
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Speciality | Clinic/Center |
Location | 167 Gawthrop Rd, Buckhannon, West Virginia |
Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
Authorized Official Contact | 3043177275 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | 167 Gawthrop Rd Buckhannon WV 26201-3927 Ph: (304) 473-5690 |
NPI Number | 1811366248 |
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Provider Enumeration Date | 09/16/2015 |
Last Update Date | 09/06/2024 |
Medicare PECOS PAC ID | 0446232987 |
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Medicare Enrollment ID | O20151015001629 |
Identifier | Type | State | Issuer |
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1811366248 | NPI | - | NPPES |
2468-5535 | Other | WV | WV STATE TAX DEPT |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 34 N Kanawha St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-6699 | |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 33 E Victoria St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-5460 | |