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2 Mountaineer Dr Clarksburg WV 26301-5511 | |
(304) 326-7620 | |
(304) 924-5460 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2 Mountaineer Dr, Clarksburg, West Virginia |
Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
Authorized Official Contact | 3045872541 |
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 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | 2 Mountaineer Dr Clarksburg WV 26301-5511 Ph: (304) 326-7620 |
NPI Number | 1164809802 |
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Provider Enumeration Date | 05/01/2015 |
Last Update Date | 05/01/2015 |
Medicare PECOS PAC ID | 0446232987 |
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Medicare Enrollment ID | O20150608001706 |
Identifier | Type | State | Issuer |
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1164809802 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Veterans Health Administration Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 Med Center Dr, Clarksburg, WV 26301 Phone: 304-623-3461 | |
Ucfa Physicians Network Group Of West Virginia Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2413 E Pike St, Clarksburg, WV 26301 Phone: 423-271-9911 | |