| Meadow Bridge Clinic | |
|
8971 Sewell Creek Road Meadow Bridge WV 25976 | |
| (304) 484-7755 | |
| (304) 484-6205 |
| Full Name | Meadow Bridge Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 8971 Sewell Creek Road, Meadow Bridge, West Virginia |
| Authorized Official Name and Position | Debra J Bennett (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3044386188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meadow Bridge Clinic 1502 Meadow Bridge Rd Meadow Bridge WV 25976-9655 Ph: (304) 484-7755 | Meadow Bridge Clinic 8971 Sewell Creek Road Meadow Bridge WV 25976 Ph: (304) 484-7755 |
| NPI Number | 1093883324 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 11/16/2023 |
| Medicare PECOS PAC ID | 7416861810 |
|---|---|
| Medicare Enrollment ID | O20040310000112 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093883324 | NPI | - | NPPES |
| 0035241003 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Crystal Sheaves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811980378 PECOS PAC ID: 1951209840 Enrollment ID: I20031230000343 |
| Provider Name | Pamela S Butcher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730172297 PECOS PAC ID: 6800795337 Enrollment ID: I20040105000360 |
| Provider Name | Robert Eugene Olexo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518968031 PECOS PAC ID: 6901880426 Enrollment ID: I20040614001124 |
| Provider Name | Rhonda L Hamm |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538184429 PECOS PAC ID: 7810978145 Enrollment ID: I20040825000359 |
| Provider Name | Melody H Ruskin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669436853 PECOS PAC ID: 6305867284 Enrollment ID: I20051207001102 |
| Provider Name | Jennifer Lynn Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205823465 PECOS PAC ID: 5890767883 Enrollment ID: I20051228000458 |
| Provider Name | Douglas R Eitel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275598989 PECOS PAC ID: 5991728933 Enrollment ID: I20060105000418 |
| Provider Name | David L Hyler-both |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154424000 PECOS PAC ID: 4082711007 Enrollment ID: I20070525000060 |
| Provider Name | Timothy O Workman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366447450 PECOS PAC ID: 6305946278 Enrollment ID: I20070706000019 |
| Provider Name | Samantha A Mann |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1003915711 PECOS PAC ID: 2264512722 Enrollment ID: I20080109000596 |
| Provider Name | Ashley Fritzius |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083889323 PECOS PAC ID: 3678648177 Enrollment ID: I20080819000015 |
| Provider Name | Kay Mccoy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669616918 PECOS PAC ID: 6800940719 Enrollment ID: I20090812000099 |
| Provider Name | Patricia E Lally |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871564245 PECOS PAC ID: 6305991241 Enrollment ID: I20090828000472 |
| Provider Name | Heather L Ratliff |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1982825428 PECOS PAC ID: 5597813451 Enrollment ID: I20091028000746 |
| Provider Name | Vicki L Gallaher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487956173 PECOS PAC ID: 7214108174 Enrollment ID: I20110926000500 |
| Provider Name | Rachel Leah Levan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497901557 PECOS PAC ID: 6103960984 Enrollment ID: I20120516000105 |
| Provider Name | Lisa M Kessler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376837757 PECOS PAC ID: 5092979435 Enrollment ID: I20120614000271 |
| Provider Name | Jerra L Shuff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265705909 PECOS PAC ID: 4486819745 Enrollment ID: I20120711000597 |
| Provider Name | James David Scott |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326071184 PECOS PAC ID: 9335180132 Enrollment ID: I20121023000509 |
| Provider Name | Christopher A Martin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851407142 PECOS PAC ID: 6608961297 Enrollment ID: I20121206000224 |
| Provider Name | Ashley R Toler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699903021 PECOS PAC ID: 9133374382 Enrollment ID: I20130219000534 |
| Provider Name | Cindy D Mann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467793091 PECOS PAC ID: 6901030295 Enrollment ID: I20130927000215 |
| Provider Name | Crystal Yvonne Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942567763 PECOS PAC ID: 1254551443 Enrollment ID: I20141010001620 |
| Provider Name | Jessica L Wickline |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235418005 PECOS PAC ID: 7012138183 Enrollment ID: I20141015001375 |
| Provider Name | Laura R Eagle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689070757 PECOS PAC ID: 9032435482 Enrollment ID: I20150303001301 |
| Provider Name | Hannah Broadwater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609256676 PECOS PAC ID: 4385958412 Enrollment ID: I20150804003716 |
| Provider Name | Fonda Deeann Harrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417200445 PECOS PAC ID: 7416258801 Enrollment ID: I20160130000100 |
| Provider Name | Joy Ann Butcher-winfree |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427139260 PECOS PAC ID: 3476850546 Enrollment ID: I20160405001170 |
| Provider Name | Christine A Barnett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750825238 PECOS PAC ID: 3375827843 Enrollment ID: I20170228001923 |
| Provider Name | Marie D Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992250625 PECOS PAC ID: 6204111693 Enrollment ID: I20170327002660 |
| Provider Name | Caitlin Renee Elswick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932612470 PECOS PAC ID: 7012278112 Enrollment ID: I20180307000270 |
| Provider Name | Destiny Hayes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316454549 PECOS PAC ID: 7214298280 Enrollment ID: I20180308000708 |
| Provider Name | Hannah Dawn Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235622168 PECOS PAC ID: 0648528372 Enrollment ID: I20180813000247 |
| Provider Name | Daonna A Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285128272 PECOS PAC ID: 8628329620 Enrollment ID: I20181001000639 |
| Provider Name | Christy M Wickline |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821496548 PECOS PAC ID: 0446577613 Enrollment ID: I20190416001388 |
| Provider Name | Steven Patirck O'field |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306361670 PECOS PAC ID: 6507191137 Enrollment ID: I20190718000754 |
| Provider Name | Julie Quillin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548793623 PECOS PAC ID: 8527337062 Enrollment ID: I20190822000956 |
| Provider Name | Sherri Sue Faulkiner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295398402 PECOS PAC ID: 9032449004 Enrollment ID: I20190918002039 |
| Provider Name | Rhonda Lea Witt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487298584 PECOS PAC ID: 3779902770 Enrollment ID: I20200924001130 |
| Provider Name | Brittany Nicole Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093368201 PECOS PAC ID: 3375871791 Enrollment ID: I20200928002352 |
| Provider Name | Kenneth Earl Gwinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003417023 PECOS PAC ID: 5395152169 Enrollment ID: I20210323000065 |
| Provider Name | Tonia Tawes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477221539 PECOS PAC ID: 7012309651 Enrollment ID: I20220112000006 |
| Provider Name | Micah Nicole Pritt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003572488 PECOS PAC ID: 6406233071 Enrollment ID: I20220520000262 |
| Provider Name | Rebecca Zarko |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699871715 PECOS PAC ID: 1759639768 Enrollment ID: I20230323001810 |
| Provider Name | Jennifer Ratliff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396204251 PECOS PAC ID: 3072929108 Enrollment ID: I20230323002433 |
| Provider Name | Erin Justice |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093230179 PECOS PAC ID: 5395194492 Enrollment ID: I20231214002927 |
| Provider Name | Shari Modlin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770912917 PECOS PAC ID: 9436454626 Enrollment ID: I20231214003666 |
| Provider Name | Daren Wadsworth |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1932727971 PECOS PAC ID: 4981042223 Enrollment ID: I20240404002971 |
| Provider Name | Carol Ann Lewis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285261271 PECOS PAC ID: 5597104067 Enrollment ID: I20240416004148 |
Meadow Bridge Clinic Paas Fqhc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1502 Meadow Bridge Road, Meadow Bridge, WV 25976 Phone: 304-484-7755 Fax: 304-484-6205 |