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300 Blue Devil Lane Kermit WV 25661 | |
| (304) 236-5902 | |
| (304) 235-7041 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 300 Blue Devil Lane, Kermit, West Virginia |
| Authorized Official Name and Position | Christopher Donovan Beckett (CEO) |
| Authorized Official Contact | 3042365902 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2080 Williamson WV 25661-2080 Ph: (304) 236-5902 | 300 Blue Devil Lane Kermit WV 25661 Ph: (304) 236-5902 |
| NPI Number | 1083260129 |
|---|---|
| Provider Enumeration Date | 08/14/2019 |
| Last Update Date | 09/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083260129 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Justice Medical Complex Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Rr Box 330 Us Hwy 52, Kermit, WV 25669 Phone: 304-393-4004 Fax: 304-393-4167 | |