| Ryan White Program Grant | |
|
3200 Maccorkle Ave Se Outpatient Care Clinic Charleston WV 25304-1227 | |
| (304) 388-8909 | |
| Not Available |
| Full Name | Ryan White Program Grant |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 3200 Maccorkle Ave Se, Charleston, West Virginia |
| Authorized Official Name and Position | Jeffrey H. Goode (PRESIDENT) |
| Authorized Official Contact | 3043887784 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ryan White Program Grant 415 Morris St Suite 304 Charleston WV 25301-1842 Ph: (304) 388-7783 | Ryan White Program Grant 3200 Maccorkle Ave Se Outpatient Care Clinic Charleston WV 25304-1227 Ph: (304) 388-8909 |
| NPI Number | 1356541114 |
|---|---|
| Provider Enumeration Date | 07/20/2007 |
| Last Update Date | 11/15/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356541114 | NPI | - | NPPES |
| 3810009608 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
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