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107 Ritchie Co School Road Ellenboro WV 26346 | |
(304) 869-3650 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 107 Ritchie Co School Road, Ellenboro, West Virginia |
Authorized Official Name and Position | Amy Yokum (CEO) |
Authorized Official Contact | 3046434005 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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L-4162 Columbus OH 43260-0001 Ph: (304) 643-4005 | 107 Ritchie Co School Road Ellenboro WV 26346 Ph: (304) 869-3650 |
NPI Number | 1518083070 |
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Provider Enumeration Date | 03/22/2007 |
Last Update Date | 05/09/2023 |
Medicare PECOS PAC ID | 0244142453 |
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Medicare Enrollment ID | O20101108000709 |
Identifier | Type | State | Issuer |
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1518083070 | NPI | - | NPPES |
3810008952 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |