| Modern Medicine Inc | |
|
4114 1st Ave Nitro WV 25143 | |
| (304) 755-0119 | |
| (304) 755-0111 |
| Full Name | Modern Medicine Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4114 1st Ave, Nitro, West Virginia |
| Authorized Official Name and Position | Elias Haikal (PRESIDENT) |
| Authorized Official Contact | 3047550119 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Medicine Inc 4114 1st Ave Nitro WV 25143-1304 Ph: (304) 755-0119 | Modern Medicine Inc 4114 1st Ave Nitro WV 25143 Ph: (304) 755-0119 |
| NPI Number | 1942256821 |
|---|---|
| Provider Enumeration Date | 05/25/2006 |
| Last Update Date | 04/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942256821 | NPI | - | NPPES |
| 6604540001 | Other | WV | DME MAC |
| 0055458000. | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1111 (West Virginia) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 11111 (West Virginia) | Secondary |
G. Mark Moreland M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2206 22nd St, Nitro, WV 25143 Phone: 304-755-1571 Fax: 304-755-3091 | |
Nitro Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4111 1st Ave, Nitro, WV 25143 Phone: 304-755-4797 | |
Phoenix Treatment Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4114 1st Ave, Nitro, WV 25143 Phone: 304-755-0119 |