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1319 Hal Greer Blvd Huntington WV 25701-3803 | |
| (304) 529-6060 | |
| (304) 529-6062 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1319 Hal Greer Blvd, Huntington, West Virginia |
| Authorized Official Name and Position | Mary-beth N. Brubeck (VP 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: (304) 781-5159 | 1319 Hal Greer Blvd Huntington WV 25701-3803 Ph: (304) 529-6060 |
| NPI Number | 1477216919 |
|---|---|
| Provider Enumeration Date | 10/21/2021 |
| Last Update Date | 12/23/2024 |
| Medicare PECOS PAC ID | 9931017969 |
|---|---|
| Medicare Enrollment ID | O20211218000169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477216919 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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