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2140 Jefferson St N Ste 200 Lewisburg WV 24901-7702 | |
(681) 484-7042 | |
(304) 438-4037 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2140 Jefferson St N Ste 200, Lewisburg, West Virginia |
Authorized Official Name and Position | Debra J Bennett (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 3044386188 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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176 Medical Center Dr Rainelle WV 25962-1064 Ph: (304) 438-6188 | 2140 Jefferson St N Ste 200 Lewisburg WV 24901-7702 Ph: (681) 484-7042 |
NPI Number | 1679223390 |
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Provider Enumeration Date | 03/25/2022 |
Last Update Date | 02/09/2023 |
Medicare PECOS PAC ID | 7416861810 |
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Medicare Enrollment ID | O20221011002709 |
Identifier | Type | State | Issuer |
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1679223390 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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