Prudich Medical Center | |
5451 Simmons River Road Montcalm WV 24737 | |
(304) 589-3251 | |
(304) 589-5363 |
Full Name | Prudich Medical Center |
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Speciality | Clinic/Center |
Location | 5451 Simmons River Road, Montcalm, West Virginia |
Authorized Official Name and Position | Rebecca Kish (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 3044315499 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Prudich Medical Center 5451 Simmons River Rd. Montcalm WV 24737 Ph: (304) 589-3251 | Prudich Medical Center 5451 Simmons River Road Montcalm WV 24737 Ph: (304) 589-3251 |
NPI Number | 1043387327 |
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Provider Enumeration Date | 11/29/2006 |
Last Update Date | 05/12/2022 |
Medicare PECOS PAC ID | 3577505221 |
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Medicare Enrollment ID | O20050831000052 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043387327 | NPI | - | NPPES |
0035334000 | Medicaid | WV | |
CD7656 | Other | WV | RR MC |
0022360001 | Medicaid | WV | |
001706661 | Other | WV | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |