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19867 Huntington Road Gallipolis Ferry WV 25515 | |
| (304) 675-5725 | |
| (304) 697-2086 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 19867 Huntington Road, Gallipolis Ferry, West Virginia |
| Authorized Official Name and Position | Mary-beth Brubeck (VICE PRESIDENT OF FINANCE / CFO) |
| Authorized Official Contact | 3045253334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1680 Huntington WV 25717-1680 Ph: (304) 697-1396 | 19867 Huntington Road Gallipolis Ferry WV 25515 Ph: (304) 675-5725 |
| NPI Number | 1194020677 |
|---|---|
| Provider Enumeration Date | 01/14/2011 |
| Last Update Date | 06/30/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194020677 | NPI | - | NPPES |
| 0097214 | Medicaid | OH | |
| 0072821 | Medicaid | OH | |
| 3810021314 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (West Virginia) | Primary |