North Fork Primary Care Clinic | |
16921 Mountaineer Drive Riverton WV 26814-0101 | |
(304) 567-2101 | |
(304) 567-2102 |
Full Name | North Fork Primary Care Clinic |
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Speciality | Clinic/Center |
Location | 16921 Mountaineer Drive, Riverton, West Virginia |
Authorized Official Name and Position | Jamie M Hudson (CEO) |
Authorized Official Contact | 3043587230 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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North Fork Primary Care Clinic Po Box 101 Riverton WV 26814-0101 Ph: (304) 567-2101 | North Fork Primary Care Clinic 16921 Mountaineer Drive Riverton WV 26814-0101 Ph: (304) 567-2101 |
NPI Number | 1417931379 |
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Provider Enumeration Date | 12/05/2005 |
Last Update Date | 07/19/2016 |
Medicare PECOS PAC ID | 3678470614 |
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Medicare Enrollment ID | O20050211000291 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417931379 | NPI | - | NPPES |
001706795 | Other | WV | MS BCBS |
5369042000 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |