Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 150 Duncan Rd, Buckeye, West Virginia |
Authorized Official Name and Position | Shannon Ruth Starcher (PROVIDER ENROLLMENT) |
Authorized Official Contact | 3047997400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
150 Duncan Rd Buckeye WV 24924 Ph: (304) 799-6200 | 150 Duncan Rd Buckeye WV 24924 Ph: (304) 799-6200 |
NPI Number | 1346523206 |
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Provider Enumeration Date | 09/27/2011 |
Last Update Date | 02/20/2020 |
Medicare PECOS PAC ID | 9234100645 |
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Medicare Enrollment ID | O20120130000489 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346523206 | NPI | - | NPPES |
3810023879 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 16 (West Virginia) | Primary |