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123 James River & Kanawha Turnpike East Ansted WV 25812-1401 | |
(855) 250-3054 | |
(304) 658-4690 |
Full Name | |
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Speciality | Family Medicine |
Location | 123 James River & Kanawha Turnpike East, Ansted, West Virginia |
Authorized Official Name and Position | Scott Keffer (PRESIDENT) |
Authorized Official Contact | 3042286809 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box A Ansted WV 25812-1401 Ph: (855) 250-3054 | 123 James River & Kanawha Turnpike East Ansted WV 25812-1401 Ph: (855) 250-3054 |
NPI Number | 1831224740 |
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Provider Enumeration Date | 02/22/2007 |
Last Update Date | 10/26/2012 |
Medicare PECOS PAC ID | 0941302921 |
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Medicare Enrollment ID | O20070221000558 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831224740 | NPI | - | NPPES |
3810018985 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 1615 (West Virginia) | Primary |
Provider Name | Scott A Keffer |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1700878881 PECOS PAC ID: 5294838371 Enrollment ID: I20070309000372 |