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100 Fair Ave Middlebourne WV 26149-9622 | |
(304) 758-5100 | |
(304) 758-4646 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 100 Fair Ave, Middlebourne, West Virginia |
Authorized Official Name and Position | Edwin Szewczyk (CFO) |
Authorized Official Contact | 3044558013 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 244 New Martinsville WV 26155-0244 Ph: (304) 455-8006 | 100 Fair Ave Middlebourne WV 26149-9622 Ph: (304) 758-5100 |
NPI Number | 1639216039 |
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Provider Enumeration Date | 02/01/2007 |
Last Update Date | 07/18/2012 |
Identifier | Type | State | Issuer |
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1639216039 | NPI | - | NPPES |
0001221009 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |