| Community Care Of West Virginia, Inc. | |
|
Rr 1 Box 5 Green Bank WV 24944-9703 | |
| (304) 456-4865 | |
| (304) 456-5162 |
| Full Name | Community Care Of West Virginia, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | Rr 1 Box 5, Green Bank, West Virginia |
| Authorized Official Name and Position | Richard G Simon (CEO) |
| Authorized Official Contact | 3049246262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care Of West Virginia, Inc. Rr 1 Box 5 Green Bank WV 24944-9703 Ph: (304) 456-4865 | Community Care Of West Virginia, Inc. Rr 1 Box 5 Green Bank WV 24944-9703 Ph: (304) 456-4865 |
| NPI Number | 1194073486 |
|---|---|
| Provider Enumeration Date | 08/17/2012 |
| Last Update Date | 08/17/2012 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20121009000581 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194073486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 90 Route 28, Green Bank, WV 24944 Phone: 304-456-5115 Fax: 304-456-5117 | |
John C Sharp Phd.,d.o. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Route 92, Green Bank, WV 24944 Phone: 304-456-4211 Fax: 304-456-5213 |