| Johnson Elementary School Wellness Center | |
|
601 Johnson Ave Bridgeport WV 26330-1971 | |
| (304) 842-2747 | |
| (304) 623-6220 |
| Full Name | Johnson Elementary School Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 601 Johnson Ave, Bridgeport, West Virginia |
| Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
| Authorized Official Contact | 3043177275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Johnson Elementary School Wellness Center 601 Johnson Ave Bridgeport WV 26330-1971 Ph: (304) 842-2747 | Johnson Elementary School Wellness Center 601 Johnson Ave Bridgeport WV 26330-1971 Ph: (304) 842-2747 |
| NPI Number | 1912392358 |
|---|---|
| Provider Enumeration Date | 04/02/2015 |
| Last Update Date | 07/25/2023 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20150521002696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912392358 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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