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1690 Holden Rd Logan WV 25601-7026 | |
(304) 239-2147 | |
(304) 239-2309 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1690 Holden Rd, Logan, West Virginia |
Authorized Official Name and Position | Kathy J. Teague (ASSISTANT VP AND SECRETARY) |
Authorized Official Contact | 6159207646 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1690 Holden Rd Logan WV 25601-7026 Ph: (304) 239-2147 | 1690 Holden Rd Logan WV 25601-7026 Ph: (304) 239-2147 |
NPI Number | 1255064531 |
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Provider Enumeration Date | 07/05/2022 |
Last Update Date | 07/28/2022 |
Medicare PECOS PAC ID | 9537078977 |
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Medicare Enrollment ID | O20220903000370 |
Identifier | Type | State | Issuer |
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1255064531 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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