| West Virginia | |
|
103 Randolph Ave # 193 Elkins WV 26241-4067 | |
| (657) 400-5180 | |
| Not Available |
| Full Name | West Virginia |
|---|---|
| Speciality | General Practice |
| Location | 103 Randolph Ave # 193, Elkins, West Virginia |
| Authorized Official Name and Position | Christopher Dennis (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 6574005180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Virginia 7755 Center Ave Ste 630 Huntington Beach CA 92647-9152 Ph: () - | West Virginia 103 Randolph Ave # 193 Elkins WV 26241-4067 Ph: (657) 400-5180 |
| NPI Number | 1194440669 |
|---|---|
| Provider Enumeration Date | 10/07/2022 |
| Last Update Date | 01/30/2024 |
| Medicare PECOS PAC ID | 8527453851 |
|---|---|
| Medicare Enrollment ID | O20230113001654 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194440669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Lena Jeanelle Gamble |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629312566 PECOS PAC ID: 5991082737 Enrollment ID: I20220728003052 |
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