| Manchin Clinic South, Llc | |
|
181 Middletown Loop White Hall WV 26554-8703 | |
| (304) 367-9170 | |
| (304) 367-9180 |
| Full Name | Manchin Clinic South, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 181 Middletown Loop, White Hall, West Virginia |
| Authorized Official Name and Position | John Manchin (SOLE MEMBER) |
| Authorized Official Contact | 3043679170 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manchin Clinic South, Llc 181 Middletown Circle Fairmont WV 26554 Ph: (304) 367-9170 | Manchin Clinic South, Llc 181 Middletown Loop White Hall WV 26554-8703 Ph: (304) 367-9170 |
| NPI Number | 1265605208 |
|---|---|
| Provider Enumeration Date | 04/10/2008 |
| Last Update Date | 07/03/2024 |
| Medicare PECOS PAC ID | 3173602091 |
|---|---|
| Medicare Enrollment ID | O20090928000199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265605208 | NPI | - | NPPES |
| 3810011616 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | John Manchin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134231640 PECOS PAC ID: 4284717182 Enrollment ID: I20080505000166 |
| Provider Name | Brandi A Powell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386974947 PECOS PAC ID: 3476740531 Enrollment ID: I20101215000466 |
Whitehall Medical Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 60 Roxbury Road, White Hall, WV 26554 Phone: 304-363-6600 Fax: 304-363-7700 |