| Living Waters Medical Center | |
|
100 Main Ave Logan WV 25601-3323 | |
| (304) 946-8350 | |
| Not Available |
| Full Name | Living Waters Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 Main Ave, Logan, West Virginia |
| Authorized Official Name and Position | Amber Ellis (DIRECTOR/FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 3049468350 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Waters Medical Center 100 Main Ave Logan WV 25601-3323 Ph: () - | Living Waters Medical Center 100 Main Ave Logan WV 25601-3323 Ph: (304) 946-8350 |
| NPI Number | 1114585619 |
|---|---|
| Provider Enumeration Date | 05/31/2019 |
| Last Update Date | 05/31/2019 |
| Medicare PECOS PAC ID | 2769711019 |
|---|---|
| Medicare Enrollment ID | O20190911002098 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114585619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jon Robert Bowen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093929036 PECOS PAC ID: 5991871204 Enrollment ID: I20080911000192 |
| Provider Name | Amber M Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093049983 PECOS PAC ID: 7113068057 Enrollment ID: I20100114000031 |
| Provider Name | Philip A Galapon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033370051 PECOS PAC ID: 6507053675 Enrollment ID: I20101215000564 |
| Provider Name | Darlene M Fields |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164738530 PECOS PAC ID: 5294923306 Enrollment ID: I20101215001257 |
| Provider Name | Samantha Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275212748 PECOS PAC ID: 7911343769 Enrollment ID: I20240314002910 |
Carlton L W Herald Do Pc Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 77 Hospital Dr, Suite 100, Logan, WV 25601 Phone: 304-831-2061 Fax: 304-831-2063 | |
Southern West Virgina Health System-logan Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 122 Nick Savas Drive, Logan, WV 25601 Phone: 304-752-8081 Fax: 304-752-8083 | |
Legacy Family Medicine Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 214 Hanging Rock Hwy, Logan, WV 25601 Phone: 304-784-4495 Fax: 304-688-9020 | |
Main Street Family Practice, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 533 Main St, Logan, WV 25601 Phone: 304-752-3400 Fax: 304-752-8138 | |
Ovp Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 557 Main St, Logan, WV 25601 Phone: 740-752-3435 Fax: 740-753-3436 | |
Absolute Care Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 Bridge St, Logan, WV 25601 Phone: 304-896-5025 Fax: 304-896-5058 |