| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 627 4th Ave, Huntington, West Virginia |
| Authorized Official Name and Position | Mary-beth Brubeck (CFO) |
| Authorized Official Contact | 3045253334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2585 3rd Ave Huntington WV 25703-1642 Ph: (304) 697-1396 | 627 4th Ave Huntington WV 25701 Ph: (304) 523-2764 |
| NPI Number | 1932174851 |
|---|---|
| Provider Enumeration Date | 02/22/2006 |
| Last Update Date | 01/23/2025 |
| Certification Date | 01/23/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932174851 | NPI | - | NPPES |
| 0088208 | Medicaid | OH | |
| 0086201 | Medicaid | OH |
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