| Rock Cave Elementary School Wellness Center | |
|
12292 Wv-20 Rock Cave WV 26234 | |
| (304) 924-5920 | |
| (304) 924-5922 |
| Full Name | Rock Cave Elementary School Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 12292 Wv-20, Rock Cave, West Virginia |
| Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 3043177275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rock Cave Elementary School Wellness Center Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | Rock Cave Elementary School Wellness Center 12292 Wv-20 Rock Cave WV 26234 Ph: (304) 924-5920 |
| NPI Number | 1194191676 |
|---|---|
| Provider Enumeration Date | 08/19/2015 |
| Last Update Date | 09/12/2024 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20151006000016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194191676 | NPI | - | NPPES |
| 2467-6966 | Other | WV | WV STATE TAX DEPT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Community Care Of Rock Cave Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 78 Queens Alley Rd, Rock Cave, WV 26234 Phone: 304-924-6262 Fax: 304-924-5460 |