| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 565 Cass Rd, Slatyfork, West Virginia |
| Authorized Official Name and Position | Shannon Ruth Starcher (PROVIDER ENROLLMENT) |
| Authorized Official Contact | 3047997400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
150 Duncan Rd Buckeye WV 24924-9037 Ph: (304) 799-7400 | 565 Cass Rd Slatyfork WV 26291 Ph: (304) 799-7400 |
| NPI Number | 1457985715 |
|---|---|
| Provider Enumeration Date | 02/26/2020 |
| Last Update Date | 08/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457985715 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Community Care Of West Virginia Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 431 Cass Rd, Slatyfork, WV 26291 Phone: 304-473-5600 Fax: 304-472-1341 |