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142 James Monroe Dr Lindside WV 24951-7168 | |
(304) 753-5940 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 142 James Monroe Dr, Lindside, West Virginia |
Authorized Official Name and Position | Michelle Ballard (COO) |
Authorized Official Contact | 3047723034 |
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 590 Union WV 24983-0590 Ph: (304) 772-3064 | 142 James Monroe Dr Lindside WV 24951-7168 Ph: (304) 753-5940 |
NPI Number | 1912440298 |
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Provider Enumeration Date | 11/18/2016 |
Last Update Date | 11/23/2022 |
Medicare PECOS PAC ID | 3173432671 |
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Medicare Enrollment ID | O20170206000717 |
Identifier | Type | State | Issuer |
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1912440298 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |