| Holistic, Inc | |
|
4815 Maccorkle Ave Se Charleston WV 25304-1948 | |
| (681) 265-1693 | |
| (681) 265-0990 |
| Full Name | Holistic, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4815 Maccorkle Ave Se, Charleston, West Virginia |
| Authorized Official Name and Position | Shawn Robert Blankenship (OWNER) |
| Authorized Official Contact | 3045531576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holistic, Inc 7 Anchors Way Winfield WV 25213-9786 Ph: (304) 553-1576 | Holistic, Inc 4815 Maccorkle Ave Se Charleston WV 25304-1948 Ph: (681) 265-1693 |
| NPI Number | 1811405616 |
|---|---|
| Provider Enumeration Date | 01/15/2018 |
| Last Update Date | 08/22/2023 |
| Medicare PECOS PAC ID | 6709140320 |
|---|---|
| Medicare Enrollment ID | O20180508001517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811405616 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (West Virginia) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | (West Virginia) | Secondary |
| Provider Name | Ghali Ibrahim-bacha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366540833 PECOS PAC ID: 6507856572 Enrollment ID: I20040514000047 |
| Provider Name | Shawn Blankenship |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851744437 PECOS PAC ID: 5496035248 Enrollment ID: I20161213001734 |
| Provider Name | Samantha B Burgess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336505049 PECOS PAC ID: 5799078358 Enrollment ID: I20171009002486 |
| Provider Name | Jamie Brumfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760046387 PECOS PAC ID: 9133457740 Enrollment ID: I20190821000316 |
| Provider Name | Kelsey L Dobbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790459618 PECOS PAC ID: 8527466085 Enrollment ID: I20211013002853 |
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