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177 Middletown Rd Ste 1 White Hall WV 26554-8254 | |
(304) 363-6600 | |
(304) 333-5201 |
Full Name | |
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Speciality | Family Medicine |
Location | 177 Middletown Rd Ste 1, White Hall, West Virginia |
Authorized Official Name and Position | Michael Tillman (CEO) |
Authorized Official Contact | 6813421000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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527 Medical Park Dr Ste 400 Bridgeport WV 26330-9010 Ph: (681) 342-3500 | 177 Middletown Rd Ste 1 White Hall WV 26554-8254 Ph: (304) 363-6600 |
NPI Number | 1194269589 |
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Provider Enumeration Date | 12/05/2016 |
Last Update Date | 12/16/2016 |
Identifier | Type | State | Issuer |
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1194269589 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Manchin Clinic South, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 181 Middletown Loop, White Hall, WV 26554 Phone: 304-367-9170 Fax: 304-367-9180 | |