| Big Elm Elementary Wellness Center | |
|
200 Tetrick Rd Shinnston WV 26431-9704 | |
| (304) 326-7280 | |
| (304) 326-7293 |
| Full Name | Big Elm Elementary Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 Tetrick Rd, Shinnston, West Virginia |
| Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
| Authorized Official Contact | 3045872541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Big Elm Elementary Wellness Center Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | Big Elm Elementary Wellness Center 200 Tetrick Rd Shinnston WV 26431-9704 Ph: (304) 326-7280 |
| NPI Number | 1649610437 |
|---|---|
| Provider Enumeration Date | 06/26/2013 |
| Last Update Date | 06/26/2013 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20131028001724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649610437 | NPI | - | NPPES |
| 2287-8118 | Other | WV | BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2287-8118 (West Virginia) | Primary |
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