| Ppadwvl Llc | |
|
3 N Main St Weaverville NC 28787-9427 | |
| (828) 713-9626 | |
| (828) 484-8956 |
| Full Name | Ppadwvl Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3 N Main St, Weaverville, North Carolina |
| Authorized Official Name and Position | Andrew Stoker (CO OWNER/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8285756421 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ppadwvl Llc 3 N Main St Weaverville NC 28787-9427 Ph: (828) 713-9626 | Ppadwvl Llc 3 N Main St Weaverville NC 28787-9427 Ph: (828) 713-9626 |
| NPI Number | 1447919196 |
|---|---|
| Provider Enumeration Date | 12/09/2021 |
| Last Update Date | 12/09/2021 |
| Medicare PECOS PAC ID | 5294129540 |
|---|---|
| Medicare Enrollment ID | O20220302001254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447919196 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Pavel Conovalciuc |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720017080 PECOS PAC ID: 4587673504 Enrollment ID: I20200601000720 |
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