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Rr 1 Box 133a Dunmore WV 24934-9708 | |
(304) 799-6564 | |
(304) 799-6893 |
Full Name | |
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Speciality | Clinic/Center |
Location | Rr 1 Box 133a, Dunmore, West Virginia |
Authorized Official Name and Position | Richard G Simon (CEO) |
Authorized Official Contact | 3049246262 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Rr 1 Box 133a Dunmore WV 24934-9708 Ph: (304) 799-6564 | Rr 1 Box 133a Dunmore WV 24934-9708 Ph: (304) 799-6564 |
NPI Number | 1043567456 |
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Provider Enumeration Date | 08/06/2012 |
Last Update Date | 08/06/2012 |
Medicare PECOS PAC ID | 0446232987 |
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Medicare Enrollment ID | O20121012000724 |
Identifier | Type | State | Issuer |
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1043567456 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |