Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 305 Clay St, Sistersville, West Virginia |
Authorized Official Name and Position | Brandon W Chadock (AO) |
Authorized Official Contact | 3046522611 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
314 S Wells St Sistersville WV 26175-1098 Ph: (304) 652-2611 | 305 Clay St Sistersville WV 26175 Ph: (304) 447-2038 |
NPI Number | 1710203419 |
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Provider Enumeration Date | 04/20/2010 |
Last Update Date | 10/21/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710203419 | NPI | - | NPPES |
3810018439 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 513412 (West Virginia) | Primary |