Full Name | |
---|---|
Speciality | Clinic/center |
Location | Rt. 103, Wilcoe, West Virginia |
Authorized Official Name and Position | Jesse Rose (ADMINISTRATOR) |
Authorized Official Contact | 3044482174 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 218 Wilcoe WV 24895-0218 Ph: (304) 448-2174 | Rt. 103 Wilcoe WV 24895 Ph: (304) 448-2174 |
NPI Number | 1487062113 |
---|---|
Provider Enumeration Date | 07/25/2014 |
Last Update Date | 07/25/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487062113 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |