| Community Care Of Bridgeport | |
|
65 Professional Pl Ste 102103 Bridgeport WV 26330-0258 | |
| (304) 848-5770 | |
| (304) 848-0890 |
| Full Name | Community Care Of Bridgeport |
|---|---|
| Speciality | Clinic/Center |
| Location | 65 Professional Pl Ste 102103, Bridgeport, 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 |
|---|---|
| Community Care Of Bridgeport Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | Community Care Of Bridgeport 65 Professional Pl Ste 102103 Bridgeport WV 26330-0258 Ph: (304) 848-5770 |
| NPI Number | 1619348844 |
|---|---|
| Provider Enumeration Date | 10/14/2015 |
| Last Update Date | 02/20/2019 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20151024000211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619348844 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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