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100 Fair St Middlebourne WV 26149-9525 | |
(304) 758-5000 | |
(304) 758-5022 |
Full Name | |
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Speciality | Clinic/Center |
Location | 100 Fair St, Middlebourne, West Virginia |
Authorized Official Name and Position | Paul Westbrock (VP, LEGAL AFFAIRS) |
Authorized Official Contact | 7403741581 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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C/o Paul Westbrock 314 S Wells St Sistersville WV 26175 Ph: (304) 652-2611 | 100 Fair St Middlebourne WV 26149-9525 Ph: (304) 758-5000 |
NPI Number | 1508465162 |
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Provider Enumeration Date | 10/23/2020 |
Last Update Date | 05/07/2021 |
Medicare PECOS PAC ID | 4385055342 |
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Medicare Enrollment ID | O20201210003158 |
Identifier | Type | State | Issuer |
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1508465162 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |