| Petersburg High School | |
|
207 Viking Dr Petersburg WV 26847-1674 | |
| (304) 257-1444 | |
| (304) 897-6216 |
| Full Name | Petersburg High School |
|---|---|
| Speciality | Clinic/Center |
| Location | 207 Viking Dr, Petersburg, West Virginia |
| Authorized Official Name and Position | Brenda Leigh Thompson (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Contact | 3048975915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Petersburg High School Po Box 97 Baker WV 26801-0097 Ph: (304) 897-5915 | Petersburg High School 207 Viking Dr Petersburg WV 26847-1674 Ph: (304) 257-1444 |
| NPI Number | 1033699087 |
|---|---|
| Provider Enumeration Date | 08/20/2018 |
| Last Update Date | 08/20/2018 |
| Medicare PECOS PAC ID | 6204728041 |
|---|---|
| Medicare Enrollment ID | O20200427000424 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033699087 | NPI | - | NPPES |
| 1033347414 | Other | WV | GROVE STREET HEALTH CENTER NIP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
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