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77 W Main St Buckhannon WV 26201-2236 | |
(304) 473-5600 | |
(304) 472-1341 |
Full Name | |
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Speciality | Clinic/Center |
Location | 77 W Main St, Buckhannon, West Virginia |
Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
Authorized Official Contact | 3043177275 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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77 W Main St Buckhannon WV 26201-2236 Ph: (304) 473-5600 | 77 W Main St Buckhannon WV 26201-2236 Ph: (304) 473-5600 |
NPI Number | 1114277050 |
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Provider Enumeration Date | 09/19/2012 |
Last Update Date | 01/19/2024 |
Medicare PECOS PAC ID | 0648189258 |
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Medicare Enrollment ID | O20121019000159 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114277050 | NPI | - | NPPES |
2198-9937 | Other | WV | WV BUSINESS REGISTRATION CERTIFICATE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2274-1060 (West Virginia) | Primary |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 34 N Kanawha St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-6699 | |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 33 E Victoria St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-5460 | |