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75 Spy Rock Loop Road Lookout WV 25868 | |
| (304) 574-2076 | |
| (304) 574-1068 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 75 Spy Rock Loop Road, Lookout, West Virginia |
| Authorized Official Name and Position | John R. Schultz (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3044692905 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
497 Mall Rd Oak Hill WV 25901-6216 Ph: () - | 75 Spy Rock Loop Road Lookout WV 25868 Ph: (304) 574-2076 |
| NPI Number | 1346426103 |
|---|---|
| Provider Enumeration Date | 01/11/2008 |
| Last Update Date | 10/09/2023 |
| Medicare PECOS PAC ID | 2365348596 |
|---|---|
| Medicare Enrollment ID | O20080129000452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346426103 | NPI | - | NPPES |
| 0035165000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1036-9138 (West Virginia) | Primary |