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100 Jerry Toth Dr Shinnston WV 26431-1903 | |
(304) 326-7400 | |
(304) 592-3415 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 100 Jerry Toth Dr, Shinnston, West Virginia |
Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
Authorized Official Contact | 3045872541 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | 100 Jerry Toth Dr Shinnston WV 26431-1903 Ph: (304) 326-7400 |
NPI Number | 1548609092 |
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Provider Enumeration Date | 06/18/2013 |
Last Update Date | 06/18/2013 |
Identifier | Type | State | Issuer |
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1548609092 | NPI | - | NPPES |
2287-8117 | Other | WV | BUSINESS LICENSE |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2287-8117 (West Virginia) | Primary |