| |
800 Independence Road Coal City WV 25823 | |
(304) 469-2905 | |
(304) 469-2981 |
Full Name | |
---|---|
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 |
---|---|
497 Mall Rd Oak Hill WV 25901-6216 Ph: (304) 469-2905 | 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 |