Midtowne Family Practice Pllc | |
904 Harrison St Princeton WV 24740-3011 | |
(304) 431-7100 | |
(304) 431-7112 |
Full Name | Midtowne Family Practice Pllc |
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Speciality | Family Medicine |
Location | 904 Harrison St, Princeton, West Virginia |
Authorized Official Name and Position | Pamela P. Faulkner (PHYSICIAN/OWNER) |
Authorized Official Contact | 3044317100 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Midtowne Family Practice Pllc Po Box 1030 Princeton WV 24740-1030 Ph: (304) 431-7100 | Midtowne Family Practice Pllc 904 Harrison St Princeton WV 24740-3011 Ph: (304) 431-7100 |
NPI Number | 1154436004 |
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Provider Enumeration Date | 08/20/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 8426172115 |
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Medicare Enrollment ID | O20100902000030 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154436004 | NPI | - | NPPES |
0051816000 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 1040 (West Virginia) | Primary |
Provider Name | Pamela P Faulkner |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1003871401 PECOS PAC ID: 9335263029 Enrollment ID: I20100902000039 |
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