| |
1200 Stephenson Ave Parkersburg WV 26101-4889 | |
(304) 699-0506 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1200 Stephenson Ave, Parkersburg, West Virginia |
Authorized Official Name and Position | Amy Yokum (CEO) |
Authorized Official Contact | 3046434005 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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L-4162 Columbus OH 43260-0001 Ph: (304) 643-4005 | 1200 Stephenson Ave Parkersburg WV 26101-4889 Ph: (304) 699-0506 |
NPI Number | 1700900818 |
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Provider Enumeration Date | 03/16/2007 |
Last Update Date | 05/09/2023 |
Medicare PECOS PAC ID | 0244142453 |
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Medicare Enrollment ID | O20101103001210 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700900818 | NPI | - | NPPES |
3810008181 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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