| Kanawha City Health Center | |
|
4602 Maccorkle Ave Se Charleston WV 25304-1848 | |
| (304) 734-2040 | |
| (304) 734-2047 |
| Full Name | Kanawha City Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 4602 Maccorkle Ave Se, Charleston, West Virginia |
| Authorized Official Name and Position | Jennifer Russell (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Contact | 3047342040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kanawha City Health Center Po Box 70 Dawes WV 25054-0070 Ph: (304) 734-2040 | Kanawha City Health Center 4602 Maccorkle Ave Se Charleston WV 25304-1848 Ph: (304) 734-2040 |
| NPI Number | 1588908362 |
|---|---|
| Provider Enumeration Date | 11/19/2012 |
| Last Update Date | 11/19/2012 |
| Medicare PECOS PAC ID | 2466431101 |
|---|---|
| Medicare Enrollment ID | O20130522000006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588908362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1041-6374 (West Virginia) | Primary |
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