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204 S Mountain Ave Mount Hope WV 25880-1129 | |
(304) 877-9133 | |
(304) 877-2165 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 204 S Mountain Ave, Mount Hope, West Virginia |
Authorized Official Name and Position | John R. Schultz (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3044692905 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 337 Scarbro WV 25917-0337 Ph: (304) 465-1378 | 204 S Mountain Ave Mount Hope WV 25880-1129 Ph: (304) 877-9133 |
NPI Number | 1952332496 |
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Provider Enumeration Date | 07/05/2006 |
Last Update Date | 05/09/2016 |
Identifier | Type | State | Issuer |
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1952332496 | NPI | - | NPPES |
3810020948 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1036-9138 (West Virginia) | Primary |