| Independence Middle School Based Health Cen | |
|
800 Independence Road Coal City WV 25823 | |
| (304) 469-2905 | |
| (304) 469-2981 |
| Full Name | Independence Middle School Based Health Cen |
|---|---|
| Speciality | Clinic/Center |
| Location | 800 Independence Road, Coal City, West Virginia |
| Authorized Official Name and Position | John R. Schultz (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3044652258 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Independence Middle School Based Health Cen 497 Mall Rd Oak Hill WV 25901-6216 Ph: (304) 469-2905 | Independence Middle School Based Health Cen 800 Independence Road Coal City WV 25823 Ph: (304) 469-2905 |
| NPI Number | 1699260224 |
|---|---|
| Provider Enumeration Date | 06/26/2018 |
| Last Update Date | 10/09/2023 |
| Medicare PECOS PAC ID | 2365348596 |
|---|---|
| Medicare Enrollment ID | O20181207001065 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699260224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (West Virginia) | Primary |
Coal City Elementary School Based Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 900 Independence Road, Coal City, WV 25823 Phone: 304-683-6904 Fax: 304-683-6903 | |
Independence School Based Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 850 Independence Road, Coal City, WV 25823 Phone: 304-683-6905 Fax: 304-683-6906 |