| Magnolia Family Medicine, Pllc | |
|
3 Ceritos Trail Martinsburg WV 25403-0300 | |
| (304) 267-6249 | |
| (304) 267-6248 |
| Full Name | Magnolia Family Medicine, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 3 Ceritos Trail, Martinsburg, West Virginia |
| Authorized Official Name and Position | Jason Bryce Swalm (SOLE MEMBER) |
| Authorized Official Contact | 3042676249 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Family Medicine, Pllc 3 Ceritos Trail Martinsburg WV 25403-0300 Ph: (304) 267-6249 | Magnolia Family Medicine, Pllc 3 Ceritos Trail Martinsburg WV 25403-0300 Ph: (304) 267-6249 |
| NPI Number | 1598212185 |
|---|---|
| Provider Enumeration Date | 09/01/2016 |
| Last Update Date | 11/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598212185 | NPI | - | NPPES |
| 1962745950 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2952 (West Virginia) | Primary |
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