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Schoolview Street Elizabeth WV 26143 | |
(304) 275-3117 | |
(304) 275-3117 |
Full Name | |
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Speciality | Clinic/Center |
Location | Schoolview Street, Elizabeth, West Virginia |
Authorized Official Name and Position | Vicki L Knicely (BILLING/CREDENTIALING SUPERVISOR) |
Authorized Official Contact | 3042753301 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 609 Elizabeth WV 26143-0609 Ph: (304) 275-3301 | Schoolview Street Elizabeth WV 26143 Ph: (304) 275-3117 |
NPI Number | 1518191923 |
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Provider Enumeration Date | 05/13/2009 |
Last Update Date | 01/03/2014 |
Medicare PECOS PAC ID | 7810806577 |
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Medicare Enrollment ID | O20140610001405 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518191923 | NPI | - | NPPES |
0009486002 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (West Virginia) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
James R. Toothman Do Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 83 Little Kanawha Pkwy, Elizabeth, WV 26143 Phone: 304-422-3904 | |