| Lumberport Elementary School Wellness Center | |
|
Chestnut & Lyndon Streets Lumberport WV 26386-0000 | |
| (304) 326-7020 | |
| (304) 584-5943 |
| Full Name | Lumberport Elementary School Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | Chestnut & Lyndon Streets, Lumberport, 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 |
|---|---|
| Lumberport Elementary School Wellness Center Po Box 217 Rock Cave WV 26234-0217 Ph: (304) 924-6262 | Lumberport Elementary School Wellness Center Chestnut & Lyndon Streets Lumberport WV 26386-0000 Ph: (304) 326-7020 |
| NPI Number | 1649610445 |
|---|---|
| Provider Enumeration Date | 06/26/2013 |
| Last Update Date | 06/26/2013 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20131028001753 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649610445 | NPI | - | NPPES |
| 2287-3648 | Other | WV | BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2287-3648 (West Virginia) | Primary |
Lumberport Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 317 Main St, Lumberport, WV 26386 Phone: 304-584-4490 Fax: 304-584-4732 | |
Lumberport Middle School Wellness Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 314 Main St, Lumberport, WV 26386 Phone: 304-326-7540 Fax: 304-584-4602 |