| Community Care Of West Virginia, Inc. | |
|
100 Jerry Toth Dr Shinnston WV 26431-1903 | |
| (304) 326-7400 | |
| (304) 592-3415 |
| Full Name | Community Care Of West Virginia, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 100 Jerry Toth Dr, Shinnston, West Virginia |
| Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
| Authorized Official Contact | 3045872541 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care Of West Virginia, Inc. Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | Community Care Of West Virginia, Inc. 100 Jerry Toth Dr Shinnston WV 26431-1903 Ph: (304) 326-7400 |
| NPI Number | 1548609092 |
|---|---|
| Provider Enumeration Date | 06/18/2013 |
| Last Update Date | 06/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548609092 | NPI | - | NPPES |
| 2287-8117 | Other | WV | BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2287-8117 (West Virginia) | Primary |
Community Care Of West Virginia, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 200 Tetrick Rd, Shinnston, WV 26431 Phone: 304-326-7280 Fax: 304-326-7293 | |
Monongahela Valley Association Of Health Center, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1 Columbia Rd, Shinnston, WV 26431 Phone: 304-592-1040 Fax: 304-592-5317 |