| |
1 Columbia Rd Shinnston WV 26431-1016 | |
(304) 592-1040 | |
(304) 592-5317 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1 Columbia Rd, Shinnston, West Virginia |
Authorized Official Name and Position | Nancy L Vandergrift (PRESIDENT) |
Authorized Official Contact | 3043678740 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1322 Locust Ave Po Box 1122 Fairmont WV 26554-1436 Ph: (304) 367-8710 | 1 Columbia Rd Shinnston WV 26431-1016 Ph: (304) 592-1040 |
NPI Number | 1710165568 |
---|---|
Provider Enumeration Date | 02/04/2008 |
Last Update Date | 03/22/2022 |
Medicare PECOS PAC ID | 6800991977 |
---|---|
Medicare Enrollment ID | O20070418000256 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710165568 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |