| Fort Ashby Family Practice | |
|
70 Presidents Street Unit 1150 Fort Ashby WV 26719-1150 | |
| (304) 298-3605 | |
| (304) 298-3578 |
| Full Name | Fort Ashby Family Practice |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 70 Presidents Street, Fort Ashby, West Virginia |
| Authorized Official Name and Position | Paul Taylor Livengood (OWNER) |
| Authorized Official Contact | 3042983605 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Ashby Family Practice 70 Presidents Street Fort Ashby WV 26719-1150 Ph: (304) 298-3605 | Fort Ashby Family Practice 70 Presidents Street Unit 1150 Fort Ashby WV 26719-1150 Ph: (304) 298-3605 |
| NPI Number | 1104962729 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 11/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104962729 | NPI | - | NPPES |
| 850-290 | Other | MAMSI MDIPA OPTIMUM | |
| H529BR | Other | MD | BCBS GROUP # |
| W399 | Other | BCBS FEDERAL PROVIDER # | |
| 00716943 | Other | WV | BCBS PROVIDER # |
| 41707101 | Other | MD | BCBS PROVIDER # |
| 3810000010 | Medicaid | WV | |
| 0003 | Other | BCBS FEDERAL GROUP # | |
| 0056043000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | 11172 (West Virginia) | Primary |
Potomac Valley Hospital Of W Va , Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10261 Frankfort Hwy, Fort Ashby, WV 26719 Phone: 304-597-3600 Fax: 304-285-3963 |