| South Harrison High School Wellness Center | |
|
Rr 1 Box 58 Lost Creek WV 26385-9707 | |
| (304) 326-7440 | |
| (304) 745-4292 |
| Full Name | South Harrison High School Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | Rr 1 Box 58, Lost Creek, West Virginia |
| Authorized Official Name and Position | Richard G Simon (CEO) |
| Authorized Official Contact | 3049246262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Harrison High School Wellness Center Rr 1 Box 58 Lost Creek WV 26385-9707 Ph: (304) 326-7440 | South Harrison High School Wellness Center Rr 1 Box 58 Lost Creek WV 26385-9707 Ph: (304) 326-7440 |
| NPI Number | 1912258492 |
|---|---|
| Provider Enumeration Date | 09/25/2012 |
| Last Update Date | 10/02/2012 |
| Medicare PECOS PAC ID | 0648189258 |
|---|---|
| Medicare Enrollment ID | O20121018000622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912258492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2274-1061 (West Virginia) | Primary |
South Harrison Middle School Wellness Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: Rr 1 Box 58b, Lost Creek, WV 26385 Phone: 304-326-7460 Fax: 304-745-5587 | |
South Harrison Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2324 Hawk Highway, Lost Creek, WV 26385 Phone: 304-745-3200 Fax: 304-745-4068 |