| Prestige Primary Care Associates, Pllc | |
|
4501 Maccorkle Ave Sw Suite 301 South Charleston WV 25309-1444 | |
| (304) 768-0700 | |
| (304) 768-9790 |
| Full Name | Prestige Primary Care Associates, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 4501 Maccorkle Ave Sw, South Charleston, West Virginia |
| Authorized Official Name and Position | Franklin Scott Moore (OWNER) |
| Authorized Official Contact | 3047680700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prestige Primary Care Associates, Pllc 4501 Maccorkle Ave Sw Suite 301 South Charleston WV 25309-1444 Ph: (304) 768-0700 | Prestige Primary Care Associates, Pllc 4501 Maccorkle Ave Sw Suite 301 South Charleston WV 25309-1444 Ph: (304) 768-0700 |
| NPI Number | 1790819373 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 10/16/2007 |
| Medicare PECOS PAC ID | 3072546621 |
|---|---|
| Medicare Enrollment ID | O20050914000422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790819373 | NPI | - | NPPES |
| 3810007578 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1212 (West Virginia) | Primary |
| 207R00000X | Internal Medicine | 1390 (West Virginia) | Secondary |
| Provider Name | John O Frame |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699799015 PECOS PAC ID: 3779516323 Enrollment ID: I20110329000978 |
| Provider Name | Franklin Scott Moore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013931443 PECOS PAC ID: 1153354709 Enrollment ID: I20110812000145 |
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