| Nicholas County School Based Health Center | |
|
30 Grizzley Ln Summersville WV 26651-9736 | |
| (304) 883-3900 | |
| (304) 872-3190 |
| Full Name | Nicholas County School Based Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 30 Grizzley Ln, Summersville, West Virginia |
| Authorized Official Name and Position | John R. Schultz (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3044692905 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicholas County School Based Health Center 497 Mall Rd Oak Hill WV 25901-6216 Ph: () - | Nicholas County School Based Health Center 30 Grizzley Ln Summersville WV 26651-9736 Ph: (304) 883-3900 |
| NPI Number | 1689669855 |
|---|---|
| Provider Enumeration Date | 09/14/2005 |
| Last Update Date | 10/09/2023 |
| Medicare PECOS PAC ID | 2365348596 |
|---|---|
| Medicare Enrollment ID | O20031209000862 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689669855 | NPI | - | NPPES |
| 0035165000 | Medicaid | WV | |
| 3810020406 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1036-9138 (West Virginia) | Primary |
| Provider Name | Joseph Ivan Golden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427040419 PECOS PAC ID: 7719924000 Enrollment ID: I20050408000064 |
| Provider Name | Richard Alan Spencer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568422640 PECOS PAC ID: 1456491612 Enrollment ID: I20091218000217 |
| Provider Name | Emily S Clagg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730355686 PECOS PAC ID: 4183768997 Enrollment ID: I20100217000520 |
| Provider Name | Whitney A Boggs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407149750 PECOS PAC ID: 3971742578 Enrollment ID: I20140912001788 |
| Provider Name | Erica Ryan Stanley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639763618 PECOS PAC ID: 0143637074 Enrollment ID: I20210322000651 |
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Summersville Family Medicine Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 211 Merchants Walk, Shopping Center, Summersville, WV 26651 Phone: 304-645-4043 | |
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