Manuel B. Villanueva M.d., P.c. | |
6070 Robert C Byrd Dr Bradley WV 25818 | |
(304) 877-2600 | |
(304) 877-2600 |
Full Name | Manuel B. Villanueva M.d., P.c. |
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Speciality | Family Medicine |
Location | 6070 Robert C Byrd Dr, Bradley, West Virginia |
Authorized Official Name and Position | Manuel B. Villanueva (OWNER) |
Authorized Official Contact | 3048772600 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Manuel B. Villanueva M.d., P.c. Po Box 265 Bradley WV 25818-0265 Ph: (304) 877-2600 | Manuel B. Villanueva M.d., P.c. 6070 Robert C Byrd Dr Bradley WV 25818 Ph: (304) 877-2600 |
NPI Number | 1457532632 |
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Provider Enumeration Date | 11/16/2007 |
Last Update Date | 05/22/2008 |
Medicare PECOS PAC ID | 4789859232 |
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Medicare Enrollment ID | O20111212000226 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457532632 | NPI | - | NPPES |
410013738 | Other | WV | RAILROAD MEDICARE |
0056004000 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 11992 (West Virginia) | Primary |