Manchin Clinic South, Llc | |
181 Middletown Loop White Hall WV 26554-8703 | |
(304) 367-9170 | |
(304) 367-9180 |
Full Name | Manchin Clinic South, Llc |
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Speciality | Clinic/Center |
Location | 181 Middletown Loop, White Hall, West Virginia |
Authorized Official Name and Position | John Manchin (SOLE MEMBER) |
Authorized Official Contact | 3043679170 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Manchin Clinic South, Llc 181 Middletown Circle Fairmont WV 26554 Ph: (304) 367-9170 | Manchin Clinic South, Llc 181 Middletown Loop White Hall WV 26554-8703 Ph: (304) 367-9170 |
NPI Number | 1265605208 |
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Provider Enumeration Date | 04/10/2008 |
Last Update Date | 07/03/2024 |
Medicare PECOS PAC ID | 3173602091 |
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Medicare Enrollment ID | O20090928000199 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265605208 | NPI | - | NPPES |
3810011616 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | John Manchin |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1134231640 PECOS PAC ID: 4284717182 Enrollment ID: I20080505000166 |
Provider Name | Brandi A Powell |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1386974947 PECOS PAC ID: 3476740531 Enrollment ID: I20101215000466 |
Uhc-whitehall Medical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 177 Middletown Rd Ste 1, White Hall, WV 26554 Phone: 304-363-6600 Fax: 304-333-5201 | |
Richard E Vasicek Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 60 Roxbury Road, White Hall, WV 26554 Phone: 304-363-6600 Fax: 304-363-7700 |