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1176 Oil Creek Rd Roanoke WV 26447-8263 | |
(304) 452-0001 | |
(304) 452-0002 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1176 Oil Creek Rd, Roanoke, West Virginia |
Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
Authorized Official Contact | 3045872541 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | 1176 Oil Creek Rd Roanoke WV 26447-8263 Ph: (304) 452-0001 |
NPI Number | 1104292168 |
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Provider Enumeration Date | 08/13/2015 |
Last Update Date | 08/25/2015 |
Medicare PECOS PAC ID | 0446232987 |
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Medicare Enrollment ID | O20151012002506 |
Identifier | Type | State | Issuer |
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1104292168 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |