| Petersen Clinic, Pllc | |
|
119 Main St W Suite A Oak Hill WV 25901-2943 | |
| (304) 465-0544 | |
| (304) 465-8832 |
| Full Name | Petersen Clinic, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 119 Main St W, Oak Hill, West Virginia |
| Authorized Official Name and Position | Bruce N. Petersen (CO-OWNER) |
| Authorized Official Contact | 3044650544 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Petersen Clinic, Pllc 119 Main St W Suite A Oak Hill WV 25901-2943 Ph: (304) 465-0544 | Petersen Clinic, Pllc 119 Main St W Suite A Oak Hill WV 25901-2943 Ph: (304) 465-0544 |
| NPI Number | 1235169384 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235169384 | NPI | - | NPPES |
| 0084786001 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 942 (West Virginia) | Primary |
| 207Q00000X | Family Medicine | 1864 (West Virginia) | Primary |
| 207R00000X | Internal Medicine | 941 (West Virginia) | Primary |
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