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59 College Ave Buckhannon WV 26201-2600 | |
(304) 924-6262 | |
(304) 924-5460 |
Full Name | |
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Speciality | Clinic/Center |
Location | 59 College Ave, Buckhannon, West Virginia |
Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 3045615319 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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59 College Ave Buckhannon WV 26201-2600 Ph: (304) 924-6262 | 59 College Ave Buckhannon WV 26201-2600 Ph: (304) 924-6262 |
NPI Number | 1487145769 |
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Provider Enumeration Date | 05/23/2018 |
Last Update Date | 05/23/2018 |
Medicare PECOS PAC ID | 0446232987 |
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Medicare Enrollment ID | O20180706001055 |
Identifier | Type | State | Issuer |
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1487145769 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 34 N Kanawha St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-6699 | |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 33 E Victoria St, Buckhannon, WV 26201 Phone: 304-924-6262 Fax: 304-924-5460 | |