| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 102 Hovater Drive, Inwood, West Virginia |
| Authorized Official Name and Position | David Fant (CEO) |
| Authorized Official Contact | 3042634999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1146 Martinsburg WV 25402-1146 Ph: (304) 263-4999 | 102 Hovater Drive Inwood WV 25428 Ph: (304) 263-4999 |
| NPI Number | 1881893550 |
|---|---|
| Provider Enumeration Date | 07/13/2007 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881893550 | NPI | - | NPPES |
| 0035217007 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
West Virginia University Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5047 Gerrardstown Rd Ste 2b, Inwood, WV 25428 Phone: 304-821-1444 Fax: 304-821-1470 |