Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 22 Fleming Dr, Harts, West Virginia |
Authorized Official Name and Position | Mary-beth Brubeck (VICE PRESIDENT OF FINANCE / CFO) |
Authorized Official Contact | 3045253334 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1680 Huntington WV 25717-1680 Ph: () - | 22 Fleming Dr Harts WV 25524 Ph: (304) 855-4595 |
NPI Number | 1649250309 |
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Provider Enumeration Date | 01/19/2006 |
Last Update Date | 03/31/2022 |
Medicare PECOS PAC ID | 9931017969 |
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Medicare Enrollment ID | O20021230000014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649250309 | NPI | - | NPPES |
CJ2698 | Other | WV | RR MEDICARE GROUP |
0035079000 | Medicaid | WV | |
614938701 | Other | WV | BLACK LUNG |